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# Meftal-Spas
## Overview
Meftal-Spas is a combination drug containing **Mefenamic Acid** (an NSAID, 250 mg) and **Dicyclomine/Dicycloverine** (an antispasmodic, 10 mg). It functions as both an analgesic/anti-inflammatory and a smooth muscle relaxant.
## Primary Indications
* Dysmenorrhea (primary).
* Abdominal cramps/spasms associated with gastrointestinal disorders.
* Musculoskeletal pain with associated muscle spasms.
## Adult Dosing
* **Standard dose:** 1 tablet (250 mg Mefenamic Acid/10 mg Dicyclomine) taken 3 to 4 times daily.
* **Maximum:** Should not exceed 1000 mg of Mefenamic Acid per 24 hours. Limit therapy to the shortest duration possible (typically 3–5 days).
## Pediatric Dosing
* **Not indicated** for children under 12 years of age due to lack of safety data and the risk profile of Mefenamic Acid.
* Consult local pediatric guidelines, as usage is generally discouraged in favor of safer alternatives (e.g., Acetaminophen or Ibuprofen).
## Dose Adjustments
* **Renal Impairment:** Contraindicated or requires extreme caution in patients with moderate to severe renal impairment (CrCl < 60 mL/min).
* **Hepatic Impairment:** Use with caution; monitor for hepatotoxicity.
* **Geriatric:** Use with caution due to increased risk of anticholinergic side effects (dicyclomine) and NSAID-related GI/renal complications.
## Contraindications
* History of GI bleeding, ulceration, or perforation.
* Hypersensitivity to Mefenamic Acid, Aspirin, or other NSAIDs.
* Severe renal or hepatic failure.
* Pre-operative pain associated with coronary artery bypass graft (CABG).
* **Dicyclomine-specific:** Obstructive uropathy, myasthenia gravis, paralytic ileus, or unstable cardiovascular status in acute hemorrhage.
## Adverse Effects
* **Dicyclomine (Anticholinergic):** Dry mouth, blurred vision, dizziness, urinary retention, constipation, and tachycardia.
* **Mefenamic Acid (NSAID):** Epigastric pain, nausea, peptic ulcer disease, increased risk of cardiovascular events, potential for interstitial nephritis or acute kidney injury.
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Diuretics/ACE Inhibitors/ARBs:** Decreased antihypertensive efficacy and increased risk of acute kidney injury.
* **Methotrexate:** Increased risk of toxicity.
* **Other Anticholinergics:** Potentiation of side effects (e.g., confusion, urinary retention).
## Monitoring
* Monitor blood pressure periodically.
* Assess renal function (Creatinine, BUN) and signs of GI irritation/occult blood in stool.
* Monitor for anticholinergic toxicity (especially in the elderly).
## Clinical Pearls
* **Administration:** Take with food or milk to minimize gastric distress.
* **Duration:** Avoid chronic use; Mefenamic Acid is strictly indicated for short-term pain relief.
* **Anticholinergic Risks:** Warn patients about potential drowsiness or blurred vision; advise caution when driving or operating machinery.
* **Allergy awareness:** If the patient has a known allergy to Aspirin, they should avoid this medication.
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**Educational Disclaimer:** This information is for educational purposes only. Drug information, regional availability, and clinical protocols vary by jurisdiction. Always verify the most current prescribing information (SmPC/Package Insert) and consult with a licensed physician or clinical pharmacist before prescribing or administering medication.
