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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
* Symptomatic relief of spasmodic pain in the gastrointestinal tract, particularly associated with conditions like irritable bowel syndrome (IBS) and dysmenorrhea.
## Adult Dosing
* **Mefenamic acid:** 250 mg to 500 mg every 6 to 8 hours as needed. Maximum daily dose: 1500 mg.
* **Dicyclomine hydrochloride:** 20 mg to 40 mg every 4 to 6 hours as needed. Maximum daily dose: 160 mg.
* **Combination Product (Meftal spas):** Typically provides a fixed combination of both agents. Dosing varies by formulation; follow product labeling or local protocol. For example, one tablet may contain 250 mg mefenamic acid and 20 mg dicyclomine. Usual dose: 1 tablet 3 times daily.
## Pediatric Dosing
* Dosing for combination products like Meftal spas is **not well established** in pediatric populations. Use with caution and consider individual agents if necessary, following specific pediatric guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted.
* **Hepatic Impairment:** Use with caution. Mefenamic acid is metabolized by the liver.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity with mefenamic acid. Consider lower doses and monitor closely.
## Contraindications
* Known hypersensitivity to mefenamic acid, dicyclomine, other NSAIDs, or anticholinergics.
* Patients with active gastrointestinal ulceration or inflammation.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Severe renal, hepatic, or cardiac impairment.
* Obstructive uropathy or gastrointestinal obstruction.
* Myasthenia gravis.
* Glaucoma (especially narrow-angle glaucoma).
* Infants less than 6 months of age (dicyclomine).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, blurred vision, dry mouth, urinary retention, drowsiness.
* **Serious:**
* **Mefenamic acid:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (interstitial nephritis, papillary necrosis); cardiovascular thrombotic events; hypersensitivity reactions; hepatic reactions; aplastic anemia.
* **Dicyclomine:** Anticholinergic effects (confusion, agitation, hallucinations, tachycardia, fever, urinary retention, constipation, blurred vision, dry mouth).
## Key Drug Interactions
* **Mefenamic acid:**
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal toxicity and reduced cardioprotective effects of aspirin.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Dicyclomine:**
* **Other anticholinergics (e.g., TCAs, antihistamines):** Potentiated anticholinergic effects.
* **Amantadine:** Increased anticholinergic adverse effects.
* **Opioid analgesics:** Increased risk of severe constipation and gastrointestinal ileus.
## Monitoring
* **GI Bleeding:** Monitor for signs/symptoms of bleeding (melena, hematemesis, abdominal pain).
* **Renal Function:** Monitor BUN and serum creatinine, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic Function:** Monitor liver enzymes if prolonged use is anticipated or if hepatic dysfunction is suspected.
* **Anticholinergic Effects:** Monitor for vision changes, urinary hesitancy, confusion, tachycardia, especially in elderly patients or those with pre-existing conditions.
## Clinical Pearls
* Meftal spas provides a dual mechanism for pain relief: anti-inflammatory action from mefenamic acid and antispasmodic action from dicyclomine.
* Limit duration of use due to potential for gastrointestinal and renal toxicity with mefenamic acid.
* Dicyclomine's anticholinergic effects can be exacerbated by heat and strenuous exercise, potentially leading to heat prostration.
* Advise patients to avoid concurrent use of alcohol and other NSAIDs.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
