Meftal%2520spas

# Meftal Spas ## Overview - **Composition:** Mefenamic acid (250 mg) + Dicyclomine hydrochloride (10 mg) per tablet (common formulation). - **Class:** NSAID (mefenamic acid) + antispasmodic (dicyclomine). - **Mechanism:** Mefenamic acid inhibits cyclooxygenase, reducing prostaglandin synthesis. Dicyclomine is a muscarinic antagonist, relaxing smooth muscle. ## Primary Indications - Dysmenorrhea (menstrual cramps) with associated smooth muscle spasm. - Abdominal colic, gastritis, irritable bowel syndrome (symptomatic relief). - Musculoskeletal pain with smooth muscle spasm (off-label, localized protocols). ## Adult Dosing - **Usual dose:** 1 tablet orally twice daily (after food). - **Maximum:** 2 tablets per day (mefenamic acid max 500 mg/day; dicyclomine max 20 mg/day). - **Duration:** Short-term (< 7 days unless prescribed). Exact regimen per local protocol. ## Pediatric Dosing - **Not recommended** for children < 12 years due to: - Dicyclomine associated risk of respiratory depression and anticholinergic toxicity in infants/young children. - Mefenamic acid not FDA-approved for pain in children < 14 years; use only if explicitly indicated per local guidelines. - **If used >12 years:** Can follow adult dose (1 tab twice daily) only if weight ≥ 40 kg and no contraindications. Individualize per local protocol. ## Dose Adjustments - **Renal impairment:** Contraindicated in GFR < 30 mL/min; use caution (dose reduction) in mild-moderate impairment. - **Hepatic impairment:** Avoid in active liver disease; use with caution. - **Elderly:** Use lowest effective dose; increased GI bleeding and anticholinergic adverse effect risk. ## Contraindications - **Mefenamic acid:** Active peptic ulcer/bleeding, history of NSAID-induced asthma/urticaria, severe renal/hepatic disease, perioperative pain after CABG, third trimester pregnancy, breastfeeding (avoid). - **Dicyclomine:** Glaucoma, myasthenia gravis, obstructive GI/GU disorders, severe ulcerative colitis, reflux esophagitis, prostatic hypertrophy, unstable cardiovascular status. - **Both:** Hypersensitivity to any component. ## Adverse Effects - **Common:** Dry mouth, blurred vision, constipation, drowsiness, dizziness, nausea, headache. - **Serious:** GI bleeding/ulceration, renal impairment, anaphylaxis, arrhythmias, anticholinergic delirium, seizures (dicyclomine overdose). ## Key Drug Interactions - **Mefenamic acid:** Warfarin (↑ INR), aspirin/other NSAIDs (↑ GI bleed), lithium/methotrexate (↑ toxicity), ACE inhibitors/diuretics (↓ efficacy). - **Dicyclomine:** Additive anticholinergic effects with antihistamines, TCAs, phenothiazines, atropine, disopyramide. - **General:** Antacids may reduce absorption; separate by 2 hours. ## Monitoring - Renal function (especially elderly, dehydrated), GI symptoms (pain, bleeding), blood pressure (fluid retention). - Anticholinergic effects (heart rate, urinary retention, mental status). - CBC and LFTs if long-term use. ## Clinical Pearls - Take with food to reduce GI upset. - Dicyclomine may cause sedation; avoid driving or operating heavy machinery. - For dysmenorrhea, start 1–2 days before expected menses for best effect. - Fixed-dose combination limits dose adjustment; consider separate agents if component titration needed. - Not a first-line antispasmodic in IBS; use limited to acute spasms. > **Disclaimer:** This information is a summary and may not reflect local formulations or dosing. Always verify current prescribing information from the manufacturer and consult institutional guidelines, especially for pediatric and off-label use. Drug interactions and adverse effects require individual assessment.