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# Meftal-Spas ## Overview Meftal-Spas is a combination drug containing **Mefenamic Acid** (an NSAID, 250mg) and **Dicyclomine/Dicycloverine** (an antispasmodic/anticholinergic, 10mg). It acts by inhibiting prostaglandin synthesis (via mefenamic acid) and providing direct smooth muscle relaxation in the gastrointestinal and urogenital tracts (via dicyclomine). ## Primary Indications Treatment of primary dysmenorrhea, abdominal cramps, and spasmodic gastrointestinal pain. ## Adult Dosing * **Standard Dose:** 1 tablet (250mg mefenamic acid / 10mg dicyclomine) taken orally 3 to 4 times daily. * **Maximum Dose:** Do not exceed 4 tablets in 24 hours. * **Duration:** Limit use to the shortest duration necessary, generally not to exceed 3-5 days. ## Pediatric Dosing * **Usage:** Not routinely recommended for children <12 years. * **Adolescents (≥12 years):** May follow adult dosing if clinically indicated and tolerated. * **Note:** Anticholinergic side effects (dicyclomine) are more pronounced in pediatric populations; use with extreme caution. ## Dose Adjustments * **Renal Impairment:** Avoid or use with extreme caution in patients with CrCl <30 mL/min. NSAIDs can precipitate acute renal failure. * **Hepatic Impairment:** Reduce frequency or avoid; mefenamic acid is extensively metabolized by the liver. * **Geriatrics:** Use lowest effective dose. Increased risk of anticholinergic side effects (confusion, urinary retention, constipation) from dicyclomine and GI bleeds from mefenamic acid. ## Contraindications * Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs. * Active peptic ulceration or inflammatory bowel disease. * Severe renal or hepatic impairment. * History of asthma or bronchospasm induced by NSAIDs. * **Dicyclomine-specific:** Glaucoma, obstructive uropathy, myasthenia gravis, or intestinal obstruction. ## Adverse Effects * **Common:** Dry mouth, dizziness, blurred vision, nausea, diarrhea, and abdominal discomfort. * **Serious:** Gastrointestinal bleeding/perforation, hypertension, acute renal impairment, skin reactions (Stevens-Johnson syndrome), and central nervous system effects (tachycardia, confusion, or urinary retention in elderly patients). ## Key Drug Interactions * **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding. * **Other NSAIDs/Corticosteroids:** Increased risk of GI ulceration. * **Antihypertensives (ACE inhibitors/Diuretics):** Decreased efficacy and increased risk of renal toxicity. * **CNS Depressants/Alcohol:** Potentiates sedative effects of dicyclomine. * **Anticholinergics:** Synergistic effects (e.g., TCA antidepressants, antihistamines) may increase side effects like constipation or confusion. ## Monitoring * Monitor for signs of GI bleeding (black stools, hematemesis). * Assess renal function (BUN/Creatinine) in long-term or high-risk patients. * Monitor blood pressure periodically. * Monitor for signs of anticholinergic toxicity (urinary retention, confusion, extreme tachycardia). ## Clinical Pearls * Take with food or milk to minimize gastric irritation. * Dicyclomine can impair ability to drive or operate machinery; warn patients accordingly. * Use as "as-needed" (PRN) therapy rather than chronic maintenance therapy due to the side effect profile of both components. * Discontinue immediately if skin rash or symptoms of liver dysfunction (jaundice) appear. *** *Disclaimer: This information is for educational purposes only. Clinical practice guidelines and local regulations vary. Always verify current prescribing information, dosage protocols, and patient-specific contraindications via official pharmaceutical resources or institutional pharmacy guidelines before prescribing or administering medication.*