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# Meftal-Spas ## Overview Meftal-Spas is a combination medication containing **Mefenamic Acid** (250 mg), a non-steroidal anti-inflammatory drug (NSAID), and **Dicyclomine Hydrochloride** (10 mg), an antispasmodic/anticholinergic agent. It is used to provide dual relief from pain and smooth muscle spasms. ## Primary Indications * Treatment of primary dysmenorrhea (menstrual cramps). * Symptomatic relief of gastrointestinal spasms (e.g., irritable bowel syndrome, intestinal colic). * Relief of abdominal pain associated with smooth muscle hypermotility. ## Adult Dosing * **Standard Dose:** 1 tablet (250 mg Mefenamic Acid / 10 mg Dicyclomine) taken 3 to 4 times daily. * **Maximum Dose:** Do not exceed 4 tablets in 24 hours. Limit use to the shortest duration necessary (typically less than 7 days). ## Pediatric Dosing * **Safety/Efficacy:** Generally **not recommended** for children under 12 years of age due to lack of extensive safety profiles for this fixed-dose combination. Pediatric dosing should be avoided unless explicitly directed by a specialist. ## Dose Adjustments * **Renal Impairment:** Avoid or exercise extreme caution in patients with renal impairment (CrCl < 30 mL/min). NSAIDs like Mefenamic Acid can precipitate acute renal failure. * **Hepatic Impairment:** Use with caution; monitor for increased risk of adverse effects. * **Geriatrics:** Dose reduction or increased monitoring is advised due to the anticholinergic effects of Dicyclomine (risk of urinary retention, confusion, constipation). ## Contraindications * Known hypersensitivity to Mefenamic Acid, Dicyclomine, or any components. * History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs. * Active peptic ulceration or inflammatory bowel disease. * Severe renal or hepatic impairment. * Patients with glaucoma, obstructive uropathy, or myasthenia gravis (due to Dicyclomine). * Coronary artery bypass graft (CABG) surgery (perioperative pain). ## Adverse Effects * **Common:** Dry mouth, blurred vision, dizziness, nausea, dyspepsia, and abdominal pain. * **Serious:** Gastrointestinal bleeding/ulceration, fluid retention, hypertension, hepatotoxicity, and serious skin reactions (e.g., Stevens-Johnson syndrome). * **Anticholinergic:** Tachycardia, urinary retention, and constipation. ## Key Drug Interactions * **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding. * **Other NSAIDs/Corticosteroids:** Increased risk of GI toxicity. * **Antihistamines/Tricyclic Antidepressants:** May potentiate the anticholinergic side effects of Dicyclomine. * **Antihypertensives:** NSAIDs may antagonize the effect of diuretics, ACE inhibitors, and beta-blockers. ## Monitoring * Monitor blood pressure periodically. * Assess for signs of GI bleeding (occult stool test) or renal function decline (BUN/Creatinine) during chronic or repetitive use. * Monitor for anticholinergic toxicity in vulnerable populations. ## Clinical Pearls * **Administration:** Take with food or milk to minimize gastrointestinal irritation. * **Dicyclomine Warning:** Avoid driving or operating machinery until the patient realizes how the medication affects them, as it may cause drowsiness or blurred vision. * **Duration:** This medication is indicated for symptomatic relief; it does not treat the underlying cause of chronic pain conditions and should not be used long-term without physician supervision. *** *Disclaimer: This information is for educational purposes only. Drug formulations, local protocols, and regulatory approvals vary by region. Always consult the current Summary of Product Characteristics (SmPC) or your local clinical pharmacist, and verify prescribing information against local hospital formulary guidelines before administration.*