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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 moderate to severe pain associated with smooth muscle spasms, particularly in the gastrointestinal and genitourinary tracts.
## Adult Dosing
* **Meftal spas:** Typically 1 tablet (mefenamic acid 250 mg / dicyclomine HCl 20 mg) every 8 hours as needed for pain.
* **Maximum dose:** Not well-established for the combination, but individual component maximums should be considered. Mefenamic acid: 500 mg every 6-8 hours. Dicyclomine HCl: Up to 40 mg per day.
## Pediatric Dosing
* Dosing for Meftal spas in pediatrics is not well-established and should be used with caution. Mefenamic acid pediatric dosing is generally based on weight. Dicyclomine pediatric dosing is also weight-based, but significant anticholinergic adverse effects can occur. Consult specific pediatric guidelines.
## Dose Adjustments
* **Renal impairment:** Mefenamic acid is primarily renally excreted. Use with caution and consider dose reduction in patients with moderate to severe renal impairment.
* **Hepatic impairment:** Use with caution. Mefenamic acid is metabolized in the liver.
* **Elderly:** Increased risk of adverse effects from NSAIDs (GI bleeding, renal toxicity) and anticholinergics (confusion, constipation, urinary retention).
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease (IBD).
* Glaucoma.
* Obstructive uropathy.
* Obstructive GI disease.
* Myasthenia gravis.
* Infants less than 6 months of age (for dicyclomine component due to risk of respiratory depression).
* Severe renal or hepatic impairment.
## Adverse Effects
* **Mefenamic acid:** Dyspepsia, nausea, vomiting, diarrhea, constipation, abdominal pain, GI bleeding, ulceration, renal toxicity, elevated liver enzymes, headache, dizziness.
* **Dicyclomine:** Dry mouth, blurred vision, urinary retention, constipation, dizziness, drowsiness, confusion, especially in the elderly.
## Key Drug Interactions
* **NSAIDs:** Increased risk of GI bleeding with concurrent use of corticosteroids, SSRIs, or anticoagulants/antiplatelets.
* **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Anticholinergics:** Additive anticholinergic effects with other agents (e.g., TCAs, antihistamines).
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in those with pre-existing renal disease or receiving concomitant nephrotoxic drugs.
* Monitor for signs of anticholinergic toxicity, particularly in the elderly.
## Clinical Pearls
* The combination of an NSAID and an antispasmodic provides both anti-inflammatory and smooth muscle relaxant effects.
* Consider the risks of NSAIDs (GI, renal, cardiovascular) and anticholinergics (CNS, urinary retention, constipation) when prescribing this combination.
* Meftal spas is typically for short-term use.
*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
