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# Meftal-Spas ## Overview Meftal-Spas is a combination analgesic and antispasmodic containing **Mefenamic Acid (250 mg)**, a non-steroidal anti-inflammatory drug (NSAID), and **Dicyclomine Hydrochloride (10 mg)**, an anticholinergic/antispasmodic agent. ## Primary Indications * Symptomatic relief of abdominal pain and cramps associated with smooth muscle spasms. * Primary dysmenorrhea (menstrual cramps). * Gastrointestinal colic and spasms. ## Adult Dosing * **Standard Dose:** 1 tablet (250 mg Mefenamic Acid / 10 mg Dicyclomine) taken 3 to 4 times daily. * **Maximum Daily Dose:** Do not exceed 4 tablets (1000 mg Mefenamic Acid / 40 mg Dicyclomine) in 24 hours. * **Duration:** Limit use to the shortest duration possible, typically not exceeding 7 days. ## Pediatric Dosing * **Children < 6 months:** Contraindicated. * **Children 6 months to 12 years:** Generally **not recommended** due to the specific combination and the risk/benefit profile of anticholinergics in pediatric populations. If used, dosing must be strictly supervised by a pediatrician. *Consult local institutional protocols/pediatric formulary guidance.* ## Dose Adjustments * **Renal/Hepatic Impairment:** Avoid or exercise extreme caution. Mefenamic acid is contraindicated in patients with significant renal impairment (CrCl < 30 mL/min). * **Elderly:** Use lowest effective dose; high risk of anticholinergic side effects (e.g., confusion, urinary retention, constipation). ## Contraindications * Hypersensitivity to Mefenamic acid, Dicyclomine, or aspirin/NSAIDs. * History of GI bleeding or peptic ulcer disease. * Severe renal or hepatic failure. * Patients with asthma or bronchospasm induced by NSAIDs. * Obstructive uropathy, intestinal obstruction, or paralytic ileus. * Severe ulcerative colitis or toxic megacolon. * Myasthenia gravis. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. ## Adverse Effects * **NSAID-related:** Gastric irritation, dyspepsia, nausea, risk of GI ulceration/bleeding, peripheral edema, decreased renal function. * **Anticholinergic-related:** Xerostomia (dry mouth), blurred vision, constipation, dizziness, urinary retention, tachycardia, and drowsiness. ## Key Drug Interactions * **Warfarin/Anticoagulants:** Increased risk of bleeding. * **Other NSAIDs/Corticosteroids:** Increased risk of gastrointestinal ulceration. * **Digoxin:** Dicyclomine may increase serum digoxin levels. * **Anticholinergics:** Concurrent use of other anticholinergics (e.g., antihistamines, tricyclic antidepressants) may lead to additive toxicity. * **Lithium/Methotrexate:** NSAIDs may decrease clearance, increasing risk of toxicity. ## Monitoring * Monitor for signs of GI bleed (stools/vomit). * Monitor blood pressure and renal function (BUN/SCr) in patients at high risk. * Observe for anticholinergic toxicity (especially in the elderly). ## Clinical Pearls * **Mechanism:** Mefenamic acid inhibits prostaglandin synthesis to address pain, while Dicyclomine acts directly on smooth muscle to inhibit spasms. * **Administration:** Take with food or milk to minimize gastric upset. * **Safety Warning:** Dicyclomine can cause drowsiness; caution patients against driving or operating heavy machinery until effect is known. * **Warning:** Despite widespread use in some regions, it is not a first-line treatment for chronic pain due to the risk of long-term NSAID use and anticholinergic side effects. *** **Educational Disclaimer:** This information is for educational purposes only. Drug dosing, indications, and contraindications change frequently. Always verify specific dosing and patient safety information against the most current local prescribing information (package insert) or clinical pharmacy database (e.g., Lexicomp, UpToDate) before prescribing or administering medication.