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# Meftal-Spas ## Overview Meftal-Spas is a combination product containing mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), and hyoscine butylbromide, an antispasmodic. ## Primary Indications * Symptomatic relief of abdominal pain and cramps associated with gastrointestinal disorders, such as irritable bowel syndrome. * Painful menstruation (dysmenorrhea). ## Adult Dosing * **Gastrointestinal spasms and dysmenorrhea:** 1 tablet (mefenamic acid 250 mg / hyoscine butylbromide 10 mg) three times daily. * **Maximum dose:** Not explicitly defined for the combination, but individual component limits should be considered. For mefenamic acid, typically 1500 mg/day. For hyoscine butylbromide, typically 100 mg/day. ## Pediatric Dosing * Dosing for pediatric patients is not established for this combination product. Mefenamic acid is generally not recommended for children under 12 years without specific medical guidance. ## Dose Adjustments * **Renal Impairment:** Mefenamic acid should be used with caution in patients with renal impairment. * **Hepatic Impairment:** Mefenamic acid should be used with caution in patients with hepatic impairment. * **Elderly:** Use with caution, as NSAIDs can cause more serious adverse effects in older adults. ## Contraindications * Hypersensitivity to mefenamic acid, hyoscine butylbromide, or any component of the formulation. * Active or history of gastrointestinal ulceration or bleeding. * Severe renal or hepatic impairment. * Myasthenia gravis. * Tachycardia. * Angle-closure glaucoma. * Prostatic hypertrophy with urinary retention. * Ileus or paralytic ileus. * Pregnancy (especially third trimester) and breastfeeding (mefenamic acid). ## Adverse Effects * **Mefenamic Acid:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dyspepsia, rash, dizziness, headache, tinnitus. Rarely, serious GI bleeding, ulceration, perforation, renal dysfunction, hepatic dysfunction, Stevens-Johnson syndrome. * **Hyoscine Butylbromide:** Dry mouth, blurred vision, constipation, urinary retention, tachycardia, drowsiness. ## Key Drug Interactions * **Mefenamic Acid:** * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect; increased risk of renal dysfunction. * **Lithium:** Increased lithium levels. * **Methotrexate:** Increased methotrexate toxicity. * **Hyoscine Butylbromide:** * **Other anticholinergics:** Potentiated anticholinergic effects. * **Amantadine:** Potentiated anticholinergic effects. * **Dopamine antagonists (e.g., metoclopramide):** Reduced efficacy of both. ## Monitoring * Monitor for signs and symptoms of gastrointestinal bleeding or ulceration. * Monitor renal and hepatic function, particularly in patients with pre-existing impairment or those on long-term therapy. * Monitor for signs of anticholinergic side effects. ## Clinical Pearls * Meftal-Spas should be taken with food or milk to minimize gastrointestinal upset. * Due to the anticholinergic effects of hyoscine butylbromide, caution is advised in patients with conditions that can be exacerbated by these effects. * The duration of treatment should be as short as possible. **Disclaimer:** This information is intended for clinical use and does not replace professional medical advice. Always refer to the most current prescribing information and consult with a healthcare provider for individual patient management.