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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid, an NSAID, and dicyclomine, an anticholinergic antispasmodic. Mefenamic acid inhibits prostaglandin synthesis, reducing inflammation and pain. Dicyclomine acts on the smooth muscle of the gastrointestinal tract to relieve spasms.
## Primary Indications
* Symptomatic relief of abdominal pain and spasms associated with irritable bowel syndrome (IBS) and other gastrointestinal disorders.
## Adult Dosing
* **Standard dose:** 1 tablet (mefenamic acid 250 mg / dicyclomine 10 mg) orally three times daily.
* **Maximum dose:** Not well-defined for the combination product. Mefenamic acid maximum daily dose is generally 1500 mg. Dicyclomine maximum daily dose is generally 40 mg.
## Pediatric Dosing
* **Children under 12 years:** Safety and efficacy have not been established.
## 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 is metabolized in the liver.
* **Elderly:** Use with caution due to increased risk of adverse effects associated with NSAIDs and anticholinergics.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs.
* Active gastrointestinal bleeding or ulceration.
* Inflammatory bowel disease (severe).
* Glaucoma.
* Myasthenia gravis.
* Obstructive uropathy.
* Obstructive gastrointestinal disease.
* Unstable heart failure.
* Pregnancy (especially third trimester).
* Severe renal or hepatic impairment.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dizziness, dry mouth, blurred vision, constipation, drowsiness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic dysfunction; cardiovascular thrombotic events; hypersensitivity reactions; anticholinergic toxicity (e.g., confusion, urinary retention, tachycardia).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of gastrointestinal adverse effects and may reduce cardioprotective effects of low-dose aspirin.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** NSAIDs can reduce their antihypertensive effect and increase risk of renal impairment.
* **Anticholinergics:** Additive anticholinergic effects with dicyclomine.
* **Lithium:** NSAIDs can increase lithium levels.
* **Methotrexate:** NSAIDs can increase methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Renal and hepatic function (especially in patients with pre-existing impairment or elderly).
* Blood pressure.
* Signs of anticholinergic toxicity.
## Clinical Pearls
* This combination is generally reserved for patients with both pain and spasm.
* Administer with food or milk to minimize gastrointestinal upset.
* Due to the anticholinergic component, caution is advised in elderly patients and those with conditions where anticholinergics are contraindicated.
* Discontinue if signs of gastrointestinal bleeding or severe adverse effects occur.
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*Disclaimer: This information is intended for clinical use and does not substitute for professional medical judgment. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
