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# Meftal Spas (Mefenamic Acid and Dicyclomine Hydrochloride)
## Overview
Meftal Spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic.
## Primary Indications
* Relief of abdominal pain associated with gastrointestinal spasms.
## Adult Dosing
* **Recommended dose:** One tablet (mefenamic acid 250 mg, dicyclomine HCl 20 mg) three times daily.
* **Maximum dose:** Not explicitly defined for the combination product, but individual component maximums should be considered. Mefenamic acid typically 750 mg every 6 hours or 1000 mg every 8 hours. Dicyclomine typically 20 mg four times daily.
## Pediatric Dosing
* Safety and efficacy in pediatric patients have not been established. Dosing should be determined by a healthcare provider based on individual patient factors.
## Dose Adjustments
* **Renal impairment:** Mefenamic acid should be used with caution or avoided in patients with severe renal impairment.
* **Hepatic impairment:** Mefenamic acid should be used with caution in patients with hepatic impairment.
* **Elderly:** Consider decreased renal and hepatic function.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease.
* Gastrointestinal obstruction, paralytic ileus.
* Uncontrolled narrow-angle glaucoma.
* Myasthenia gravis.
* Severe renal or hepatic impairment.
* Severe ulcerative colitis.
## Adverse Effects
* **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, constipation, dizziness, headache.
* **Common (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness, weakness, nervousness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events; renal toxicity; hepatic toxicity; severe hypersensitivity reactions; exacerbation of glaucoma; paralytic ileus.
## Key Drug Interactions
* **Mefenamic Acid:** Anticoagulants (e.g., warfarin), aspirin, corticosteroids, selective serotonin reuptake inhibitors (SSRIs), other NSAIDs, diuretics, ACE inhibitors, ARBs, lithium, methotrexate.
* **Dicyclomine:** Anticholinergic agents, amantadine, quinidine, MAO inhibitors, antihistamines, CNS depressants.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding or ulceration.
* Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing impairment.
* Monitor for anticholinergic side effects.
## Clinical Pearls
* Short-term use is recommended due to the risk of serious gastrointestinal events.
* Administer with food or milk to minimize gastrointestinal upset.
* Caution patients regarding activities requiring mental alertness (e.g., driving) due to potential dizziness or drowsiness.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and guidelines for complete details. Dosing and indications may vary based on local protocols and individual patient circumstances.*
