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# Meftal-Spas
## Overview
Meftal-Spas is a combination preparation containing **Mefenamic Acid** (250 mg), an NSAID, and **Dicyclomine Hydrochloride** (10 mg), an antispasmodic. It acts by inhibiting prostaglandin synthesis (to reduce inflammation and pain) and exerting direct antispasmodic action on smooth muscle.
## Primary Indications
* Symptomatic relief of spasmodic dysmenorrhea (menstrual cramps).
* Abdominal pain/colic associated with gastrointestinal or gynecological smooth muscle spasms.
## Adult Dosing
* **Standard Dose:** 1 tablet (250 mg/10 mg) taken 3–4 times daily, as needed.
* **Maximum Dose:** Not to exceed 4 tablets (1000 mg Mefenamic Acid/40 mg Dicyclomine) per 24 hours.
* **Duration:** Use for the shortest duration necessary; generally not to exceed 3–5 days due to NSAID safety profile.
## Pediatric Dosing
* **Generally not recommended** for children under 12 years of age due to the risks associated with Mefenamic Acid and Dicyclomine in pediatric populations. Its use in pediatrics is off-label and varies by local clinical protocol.
## Dose Adjustments
* **Renal Impairment:** Avoid or use with extreme caution in moderate-to-severe renal impairment (CrCl < 60 mL/min).
* **Hepatic Impairment:** Use with caution; discontinue if liver function markers become abnormal.
* **Geriatric:** Avoid in patients >65 due to increased risk of anticholinergic side effects (Dicyclomine) and gastrointestinal/renal complications (Mefenamic Acid).
## Contraindications
* Known hypersensitivity to Mefenamic Acid, Aspirin, or other NSAIDs (risk of bronchospasm/anaphylaxis).
* History of active peptic ulceration, gastrointestinal bleeding, or chronic inflammation of the GI tract.
* Severe hepatic or renal impairment.
* Obstructive uropathy, glaucoma, myasthenia gravis, or paralytic ileus (due to Dicyclomine).
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **GI:** Nausea, abdominal pain, diarrhea, risk of GI ulceration/bleeding.
* **Anticholinergic (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, tachycardia, and dizziness.
* **Systemic:** Potential for fluid retention, hypertension, and rare cases of hepatotoxicity or skin rashes (Stevens-Johnson syndrome).
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., Warfarin):** Increased risk of bleeding.
* **Other NSAIDs/Corticosteroids:** Increased risk of GI toxicity.
* **Antihypertensives (e.g., ACE inhibitors, Diuretics):** Reduced efficacy of antihypertensive therapy and increased risk of renal failure.
* **CNS Depressants:** Dicyclomine may potentiate the effects of alcohol or other sedatives.
## Monitoring
* Monitor blood pressure and renal function (serum creatinine) with long-term use.
* Monitor for signs of GI bleeding (occult blood in stool, persistent epigastric pain).
* Monitor for anticholinergic toxicity in elderly patients (confusion, urinary retention).
## Clinical Pearls
* **Administration:** Administer with or immediately after food to minimize gastrointestinal irritation.
* **Dicyclomine effect:** Patients should be advised that the medication may cause drowsiness or blurred vision; perform tasks requiring mental alertness with caution until the drug’s individual response is known.
* **Short-term use:** Do not use as a long-term analgesic for chronic pain.
* **Uncertainty:** Dosing protocols vary significantly by geographic region; always defer to the specific Summary of Product Characteristics (SmPC) provided by the local manufacturer for the specific formulation.
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**Disclaimer:** This information is for educational purposes only. Drug information, contraindications, and dosing guidelines change frequently. Always consult the latest package insert, official prescribing information, or a clinical pharmacist before prescribing or administering any medication.
