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# Meftal Spas ## Overview Meftal Spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine, an anticholinergic antispasmodic. ## Primary Indications * Relief of abdominal pain and cramps associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders. * Management of dysmenorrhea. ## Adult Dosing * **General:** 1 tablet (mefenamic acid 250 mg / dicyclomine 10 mg) three times daily. * **Maximum:** Not clearly established for the combination product. Mefenamic acid maximum is typically 750 mg per dose or 3000 mg per day. Dicyclomine maximum is typically 40 mg per day. ## Pediatric Dosing * Dosing for Meftal Spas in pediatric patients is not well-established. Mefenamic acid dosing for children 6 months and older is typically 5-7 mg/kg/dose every 6-8 hours. Dicyclomine is generally not recommended for infants and young children due to potential serious side effects. **Use in pediatric patients requires careful consideration and consultation with a pediatrician.** ## Dose Adjustments * **Renal Impairment:** Mefenamic acid should be used with caution in patients with renal impairment. Dicyclomine clearance is reduced in renal impairment. * **Hepatic Impairment:** Mefenamic acid should be used with caution in patients with hepatic impairment. * **Elderly:** Elderly patients may be more susceptible to the adverse effects of NSAIDs and anticholinergics. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics. * Active gastrointestinal ulceration or bleeding. * Inflammatory bowel disease (active or history). * Severe renal or hepatic impairment. * Glaucoma. * Myasthenia gravis. * Obstructive uropathy. * Obstructive gastrointestinal disorders. * Unstable heart failure. * Children under 6 months of age (for dicyclomine component). ## Adverse Effects * **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, dizziness, headache, rash. * **Common (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion. * **Serious:** * **Mefenamic Acid:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic failure; cardiovascular thrombotic events; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis. * **Dicyclomine:** Severe anticholinergic effects (especially in the elderly or those with impaired renal function), including delirium, hallucinations, and cardiovascular effects. ## Key Drug Interactions * **Mefenamic Acid:** * Anticoagulants (e.g., warfarin): Increased risk of bleeding. * Corticosteroids: Increased risk of gastrointestinal ulceration and bleeding. * SSRIs/SNRIs: Increased risk of bleeding. * ACE inhibitors, ARBs, beta-blockers: Reduced antihypertensive effect, increased risk of renal impairment. * Diuretics: Reduced diuretic and antihypertensive effect, increased risk of renal impairment. * Lithium, Methotrexate: Increased serum levels and toxicity. * **Dicyclomine:** * Other anticholinergics (e.g., tricyclic antidepressants, antihistamines, amantadine): Potentiated anticholinergic effects. * MAO inhibitors: May increase anticholinergic effects. * Potassium chloride: Increased risk of gastrointestinal ulceration. ## Monitoring * Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis). * Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing conditions. * Assess for adverse effects of both mefenamic acid and dicyclomine. ## Clinical Pearls * Meftal Spas should be taken with food or milk to minimize gastrointestinal upset. * Due to the anticholinergic effects of dicyclomine, caution is advised when driving or operating machinery. * Hydration is important, especially with diarrhea or vomiting. * Use the lowest effective dose for the shortest duration necessary. * Consider individual patient risk factors for NSAID-related complications. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details and to verify this information before patient care. Dosing and indications may vary by local formulary and protocol.