Meftal%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# Meftal Spas ## Overview Meftal Spas is a combination medication containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic. Mefenamic acid reduces inflammation and pain, while dicyclomine reduces spasms of the gastrointestinal tract. ## Primary Indications * Pain associated with muscle spasms, particularly in the abdomen. * Dysmenorrhea (menstrual pain). ## Adult Dosing * **Meftal Spas Tablet:** 1 tablet (containing mefenamic acid 250 mg and dicyclomine HCl 20 mg) every 8 hours as needed. * **Maximum daily dose:** Not explicitly established, but typically should not exceed 750 mg of mefenamic acid and 75 mg of dicyclomine hydrochloride per day to minimize risks. Dosing should be for the shortest duration necessary. ## Pediatric Dosing Dosing for children is not well-established for this specific combination product. Mefenamic acid can be dosed in children 6 months and older, but dicyclomine use in pediatrics requires careful consideration of contraindications and potential adverse effects. Consult specific pediatric guidelines or a pediatrician. ## Dose Adjustments * **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted. Dose reduction may be necessary in severe impairment. * **Hepatic Impairment:** Use with caution. Mefenamic acid can affect liver function. * **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal events. Use cautiously. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs/anticholinergics. * History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Inflammatory bowel disease. * Gastrointestinal obstruction or severe constipation. * Glaucoma (especially angle-closure glaucoma). * Myasthenia gravis. * Infants less than 6 months of age (due to dicyclomine). * Severe renal or hepatic impairment. * Heart failure. ## Adverse Effects * **Common (Mefenamic Acid):** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, rash. * **Common (Dicyclomine):** Dry mouth, blurred vision, dizziness, drowsiness, urinary retention, constipation. * **Serious:** * **Gastrointestinal:** GI bleeding, ulceration, perforation. * **Cardiovascular:** Increased risk of myocardial infarction and stroke. * **Renal:** Renal failure, interstitial nephritis. * **Hepatic:** Hepatitis, jaundice. * **Allergic:** Anaphylaxis, Stevens-Johnson syndrome, TEN. * **Anticholinergic toxicity:** Confusion, hallucinations, significant tachycardia, heat prostration. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and additive effects. * **ACE inhibitors/ARBs/Diuretics:** May reduce antihypertensive effect and increase risk of renal impairment. * **Lithium:** Mefenamic acid can increase lithium levels. * **Anticholinergics:** Additive anticholinergic effects. * **Antacids:** May affect absorption. ## Monitoring * **Renal function:** Baseline and periodically, especially in those with pre-existing renal disease or risk factors. * **Hepatic function:** Baseline and periodically. * **Gastrointestinal symptoms:** Monitor for signs of bleeding (melena, hematemesis) or ulceration. * **Blood pressure:** Especially with NSAID use. * **Signs of anticholinergic toxicity:** Monitor for dry mouth, blurred vision, urinary retention, confusion, etc. ## Clinical Pearls * This combination product should be used for the shortest duration possible and at the lowest effective dose. * Administer with food or milk to reduce gastrointestinal upset. * Dicyclomine can cause drowsiness; advise patients to avoid driving or operating machinery until they know how the medication affects them. * The risk of serious cardiovascular events and GI bleeding increases with duration of use and higher doses. * Consider the individual risks and benefits of each component when prescribing. **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to ensure patient safety. Local protocols may vary.