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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 mild to moderate pain associated with gastrointestinal spasms.
* Painful menstruation (dysmenorrhea).
## Adult Dosing
* **Gastrointestinal Spasms/Dysmenorrhea:** 1 tablet (mefenamic acid 250 mg, dicyclomine HCl 10 mg) orally every 8 hours.
* **Maximum:** Not to exceed 4 doses in 24 hours. Duration of treatment should generally not exceed 7 days.
## Pediatric Dosing
* The use of Meftal Spas in pediatric patients is not established. Mefenamic acid and dicyclomine HCl should be used with caution and at reduced doses in children if deemed necessary, based on physician judgment and weight.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is renally excreted.
* **Hepatic Impairment:** Use with caution.
* **Elderly:** Use with caution, increased risk of adverse effects.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Inflammatory bowel disease.
* Obstructive uropathy.
* Obstructive gastrointestinal disease.
* Myasthenia gravis.
* Glaucoma (angle-closure suspected or confirmed).
* Infants less than 6 months of age.
* Third trimester of pregnancy.
## Adverse Effects
* **Common (Mefenamic Acid):** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, headache, dizziness, drowsiness.
* **Common (Dicyclomine HCl):** Dry mouth, blurred vision, urinary retention, constipation, nausea, dizziness, weakness, nervousness, confusion.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions; exacerbation of glaucoma; ileus.
## Key Drug Interactions
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal bleeding.
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Anticholinergics:** Additive anticholinergic effects.
* **Antacids:** May decrease absorption of mefenamic acid.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or on prolonged therapy.
* Monitor for anticholinergic side effects, particularly in the elderly.
## Clinical Pearls
* Should be taken with food or milk to minimize gastrointestinal upset.
* Avoid concurrent use with other NSAIDs.
* Dicyclomine can cause drowsiness; caution patients about driving or operating machinery.
* Discontinue if severe adverse effects occur.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and local protocols before making any treatment decisions.*
