Meftal%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520spas

# Meftal spas ## Overview Meftal spas is a combination product containing mefenamic acid (a nonsteroidal anti-inflammatory drug, NSAID) and hyoscine-N-butylbromide (an anticholinergic antispasmodic). ## Primary Indications * Symptomatic relief of smooth muscle spasms associated with gastrointestinal disorders, biliary tract disorders, and genitourinary tract disorders. * Management of dysmenorrhea. ## Adult Dosing * **Gastrointestinal/Biliary/Genitourinary Spasms:** 1 tablet (250 mg mefenamic acid / 10 mg hyoscine-N-butylbromide) orally every 8 hours. * **Dysmenorrhea:** 1 tablet (250 mg mefenamic acid / 10 mg hyoscine-N-butylbromide) orally every 8 hours, starting with the onset of pain. Maximum dose: Not explicitly defined for the combination, but typically NSAID limits apply. For mefenamic acid alone, the maximum daily dose is usually 1500 mg. ## Pediatric Dosing Dosing for children is not well-established for this combination product. Mefenamic acid is generally not recommended for routine use in children under 14 years of age. Hyoscine-N-butylbromide may be used in specific pediatric situations, but clear dosing for the combination is lacking. Consultation with a pediatrician or reference to pediatric-specific guidelines is recommended. ## Dose Adjustments * **Renal Impairment:** Mefenamic acid should be used with caution in patients with mild to moderate renal impairment. Dose reduction may be considered, and close monitoring for renal toxicity is advised. Avoid in severe renal impairment. * **Hepatic Impairment:** Use with caution in patients with hepatic impairment. Monitor liver function tests. * **Elderly:** Elderly patients may be at increased risk for adverse effects, particularly gastrointestinal bleeding and renal toxicity from mefenamic acid. Use with caution and at the lowest effective dose. ## Contraindications * Hypersensitivity to mefenamic acid, hyoscine-N-butylbromide, or any component of the formulation. * History of NSAID-induced bronchospasm, urticaria, or allergic rhinitis. * Active peptic ulcer or history of recurrent peptic ulceration. * Severe heart failure, severe liver failure, severe renal failure. * Obstructive uropathy or obstructive gastrointestinal lesions. * Tachyarrhythmias. * Angle-closure glaucoma. * Myasthenia gravis. * Prostatic hypertrophy with urinary retention. * Late pregnancy (third trimester). ## Adverse Effects **Common (Mefenamic Acid):** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, headache, dizziness. **Serious (Mefenamic Acid):** Gastrointestinal bleeding, ulceration, perforation; renal papillary necrosis and other renal injury; hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions, including Stevens-Johnson syndrome/toxic epidermal necrolysis; bronchospasm. **Common (Hyoscine-N-butylbromide):** Dry mouth, blurred vision, tachycardia, constipation, urinary retention, decreased sweating. **Serious (Hyoscine-N-butylbromide):** Angle-closure glaucoma, exacerbation of myasthenia gravis. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding with mefenamic acid. * **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding with mefenamic acid. * **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal side effects and potential for additive antiplatelet effects. * **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of gastrointestinal bleeding with mefenamic acid. * **Diuretics and Antihypertensives:** Mefenamic acid can reduce the efficacy of these drugs and increase the risk of nephrotoxicity. * **Lithium:** Mefenamic acid can increase lithium levels. * **Methotrexate:** Mefenamic acid can increase methotrexate toxicity. * **Cholinergic Agents:** Hyoscine-N-butylbromide antagonizes the effects of cholinergic agents. * **Amantadine, Tricyclic Antidepressants:** May potentiate the anticholinergic effects of hyoscine-N-butylbromide. ## Monitoring * **Gastrointestinal Symptoms:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis) or ulceration. * **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk. * **Hepatic Function:** Monitor liver function tests (ALT, AST), especially with long-term use or in patients with hepatic impairment. * **Blood Pressure:** Monitor blood pressure, particularly in patients receiving antihypertensive therapy. * **Hydration and Bladder Function:** Monitor for signs of urinary retention, especially in elderly men or those with prostatic hypertrophy. ## Clinical Pearls * Meftal spas should be used at the lowest effective dose for the shortest duration necessary to minimize risks. * Concomitant use with food or milk may reduce gastrointestinal upset from mefenamic acid. * The antispasmodic effect of hyoscine-N-butylbromide is primarily peripheral, with minimal central nervous system effects at therapeutic doses. * Due to the potential for blurred vision and dizziness, advise patients to exercise caution when driving or operating machinery. **Disclaimer:** This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines before making any therapeutic decisions.