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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
* Management of abdominal pain associated with gastrointestinal spasms, particularly when inflammation is also present.
## Adult Dosing
* **Meftal spas tablet:** 1 tablet (250 mg mefenamic acid and 10 mg dicyclomine HCl) every 8 hours as needed.
* **Maximum:** Not to exceed 4 tablets per day.
## Pediatric Dosing
* Data on pediatric use is limited. Dosing should be determined by a healthcare professional based on the child's weight and clinical condition. Mefenamic acid dosing is typically 5-7 mg/kg/dose every 6-8 hours for children over 6 months, not to exceed 500 mg/day. Dicyclomine is generally not recommended for infants.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mefenamic acid is primarily excreted by the kidneys.
* **Hepatic Impairment:** Use with caution. NSAIDs can affect liver function.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal dysfunction. Use the lowest effective dose for the shortest duration.
## 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.
* Gastrointestinal obstruction or atony.
* Myasthenia gravis.
* Uncontrolled glaucoma.
* Severe renal or hepatic impairment.
* Severe heart failure.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dizziness, headache, dry mouth, blurred vision.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; hepatic impairment; hypersensitivity reactions; exacerbation of glaucoma; confusion; hallucinations; urinary retention.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Other NSAIDs and Salicylates:** Increased risk of gastrointestinal toxicity.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs and SNRIs:** Increased risk of gastrointestinal bleeding.
* **Diuretics and Antihypertensives:** NSAIDs can reduce their efficacy and increase the risk of nephrotoxicity.
* **Lithium:** NSAIDs can increase lithium levels.
* **Methotrexate:** NSAIDs can increase methotrexate toxicity.
* **Anticholinergics:** Additive effects with dicyclomine (e.g., atropine, some antihistamines).
## Monitoring
* **Renal function:** Especially in the elderly or those with pre-existing renal disease.
* **Liver function:** Particularly with prolonged use or in patients with hepatic impairment.
* **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration.
* **Blood pressure:** NSAIDs can cause or worsen hypertension.
## Clinical Pearls
* Meftal spas should be used at the lowest effective dose and for the shortest duration necessary to control symptoms.
* Administer with food or milk to minimize gastrointestinal upset.
* Due to the anticholinergic effects of dicyclomine, caution is advised in patients with conditions such as prostatic hypertrophy, constipation, or certain cardiac conditions.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for clinical judgment or a review of the full prescribing information. Always verify current prescribing information and local protocols before administering any medication.
