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# Meftal-Spas
## Overview
Meftal-Spas is a combination drug containing **Mefenamic acid** (250 mg), an NSAID with analgesic and anti-inflammatory properties, and **Dicyclomine hydrochloride** (10 mg), an anticholinergic antispasmodic. The combination is primarily used to relieve pain associated with smooth muscle spasms.
## Primary Indications
Treatment of primary dysmenorrhea, spasmodic pain related to gastrointestinal (GI) or biliary disorders, and musculoskeletal pain accompanied by muscle spasms.
## Adult Dosing
* **Standard dose:** 1 tablet (250 mg mefenamic acid / 10 mg dicyclomine) orally every 6 to 8 hours as needed.
* **Maximum dose:** Do not exceed 3 to 4 tablets per day.
* **Duration:** Should be used for the shortest duration possible to control symptoms.
## Pediatric Dosing
**Not recommended** for children under 12 years of age due to potential systemic anticholinergic effects and NSAID-related toxicities. Safety and efficacy in this population are not established.
## Dose Adjustments
* **Renal Impairment:** Avoid in patients with severe renal impairment (CrCl < 30 mL/min). Dose reduction is required for mild-to-moderate impairment; use with extreme caution.
* **Hepatic Impairment:** Use with caution. If required, use the lowest effective dose for the shortest duration.
* **Elderly:** Use with caution due to increased risk of anticholinergic side effects (confusion, urinary retention) and GI bleeding.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* Active peptic ulceration, inflammatory bowel disease (IBD), or severe GI bleeding.
* History of asthma or allergic reactions triggered by NSAIDs.
* Obstructive uropathy, paralytic ileus, or unstable cardiovascular status in acute hemorrhage.
* Perioperative setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Dicyclomine-related:** Dry mouth, blurred vision, tachycardia, urinary retention, constipation, and drowsiness.
* **Mefenamic acid-related:** Dyspepsia, nausea, abdominal pain, increased risk of GI ulceration/bleeding, hypertension, fluid retention, and potential for nephrotoxicity.
* **Systemic:** CNS effects including dizziness or confusion.
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Other NSAIDs/Corticosteroids:** Increased risk of GI ulceration.
* **Anticholinergics:** Concurrent use with other anticholinergic drugs increases the risk of additive side effects (e.g., severe constipation, cognitive impairment).
* **Antihypertensives/Diuretics:** NSAIDs may reduce the efficacy of diuretics and antihypertensive medications.
## Monitoring
* Monitor blood pressure periodically.
* Assess for occult GI bleeding.
* Monitor renal function in long-term therapy.
* Observe for anticholinergic toxicity, particularly in elderly patients.
## Clinical Pearls
* **Avoid in "Spastic Colon":** While commonly prescribed for this, clinical guidelines often favor more targeted therapies for IBS; avoid if there is evidence of bowel obstruction.
* **GI Sensitivity:** To reduce gastric irritation, take with food or milk.
* **Driving/Work:** Dicyclomine may cause drowsiness or blurred vision; counsel patients to avoid operating heavy machinery until effect is known.
* **Cardiovascular Risk:** Like all NSAIDs, it carries a warning for increased risk of serious cardiovascular thrombotic events.
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**Educational Disclaimer:** This information is for educational purposes only. Dosing protocols may vary by local practice, guidelines, and clinical judgment. Always verify current prescribing information, contraindications, and patient-specific data before administration.
