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# Meftal Spas ## Overview Meftal Spas is a combination product containing mefenamic acid (a nonsteroidal anti-inflammatory drug, NSAID) and dicyclomine hydrochloride (an anticholinergic/antispasmodic). ## Primary Indications * Management of abdominal pain and spasms associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders. * Relief of pain and inflammation. ## Adult Dosing * **Meftal Spas Tablets:** 1 tablet (containing mefenamic acid 250 mg and dicyclomine HCl 10 mg) orally every 8 hours, as needed for pain and spasms. * **Meftal Spas Suspension:** 10 mL (containing mefenamic acid 50 mg/5 mL and dicyclomine HCl 5 mg/5 mL) orally every 8 hours, as needed for pain and spasms. * **Maximum Mefenamic Acid Dose:** Generally not to exceed 1000 mg per dose or 4000 mg per day for short-term use. * **Maximum Dicyclomine HCl Dose:** Typically not to exceed 40 mg per day. *Note: Specific dosing may vary based on individual patient response and physician discretion. Always follow local prescribing guidelines.* ## Pediatric Dosing * Data regarding the safety and efficacy of Meftal Spas in pediatric populations is limited. * Mefenamic acid pediatric dosing is generally weight-based (e.g., 5-7 mg/kg/dose orally every 6-8 hours). * Dicyclomine HCl pediatric dosing is also weight-based but should be used with caution due to potential anticholinergic side effects. * **It is strongly recommended to consult specific pediatric dosing guidelines or a pediatrician before administering Meftal Spas to children.** ## Dose Adjustments * **Renal Impairment:** Use with caution. Mefenamic acid is primarily renally excreted. Dose reduction may be considered in severe renal impairment. * **Hepatic Impairment:** Use with caution. Monitor liver function closely. * **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding, renal toxicity, and cardiovascular events. Use lowest effective dose. ## Contraindications * Hypersensitivity to mefenamic acid, dicyclomine, or any component of the formulation. * Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Use in the perioperative period of coronary artery bypass graft (CABG) surgery. * Active gastrointestinal bleeding or perforation. * Severe renal, hepatic, or cardiac insufficiency. * Myasthenia gravis. * Obstructive uropathy or gastrointestinal obstruction. * Uncontrolled glaucoma. * Infants less than 6 months of age (due to dicyclomine component). ## Adverse Effects * **Mefenamic Acid:** * Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, gastrointestinal bleeding, perforation, ulceration. * Renal: Renal dysfunction, interstitial nephritis, papillary necrosis. * Hepatic: Liver enzyme elevations, hepatitis. * Cardiovascular: Increased risk of myocardial infarction and stroke (especially with long-term use or in patients with risk factors). * Other: Headache, dizziness, rash, hypersensitivity reactions. * **Dicyclomine HCl:** * Anticholinergic effects: Dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion (especially in the elderly). * Other: Nausea, vomiting, dizziness. ## Key Drug Interactions * **Other NSAIDs & Aspirin:** Increased risk of gastrointestinal bleeding and renal toxicity. * **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal bleeding. * **Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of gastrointestinal bleeding. * **ACE Inhibitors, Angiotensin II Receptor Blockers (ARBs), Diuretics:** May increase the risk of renal impairment. * **Lithium:** NSAIDs can decrease renal clearance of lithium, leading to increased serum levels. * **Methotrexate:** NSAIDs can decrease the renal clearance of methotrexate, leading to potentially toxic levels. * **Anticholinergics:** Additive anticholinergic effects. * **Antacids:** May decrease absorption of dicyclomine. ## Monitoring * **Gastrointestinal Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis, abdominal pain). * **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or at risk. * **Liver Function:** Monitor LFTs, especially with prolonged use or in patients with hepatic impairment. * **Blood Pressure:** Monitor blood pressure, especially during initiation and with chronic use of NSAIDs. * **Signs of Anticholinergic Toxicity:** Particularly in the elderly. ## Clinical Pearls * Meftal Spas is intended for short-term use. Prolonged use of NSAIDs is associated with increased risks of serious cardiovascular and gastrointestinal events. * The dicyclomine component can cause drowsiness; advise patients to avoid driving or operating heavy machinery until they know how the medication affects them. * Administer with food or milk to minimize gastrointestinal upset from mefenamic acid. * Consider alternative therapies for patients with a history of peptic ulcer disease or other risk factors for gastrointestinal bleeding. * Be aware of potential interactions with other medications the patient may be taking. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.