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# Meftal-Spas
## Overview
Meftal-Spas is a combination product typically 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-action relief from pain and smooth muscle spasms.
## Primary Indications
* Primary dysmenorrhea (menstrual cramps).
* Gastrointestinal spasms and abdominal pain (e.g., irritable bowel syndrome, biliary colic).
## Adult Dosing
Standard dose is 1 tablet (Mefenamic Acid 250 mg/Dicyclomine 10 mg) three to four times daily as needed for pain.
* **Maximum Daily Dose:** Do not exceed 4 tablets in 24 hours. Limit therapy to the shortest duration necessary (typically ≤ 3 days for dysmenorrhea).
## Pediatric Dosing
**Not recommended for children under 12 years of age.** Safety and efficacy have not been established for pediatric use. Consult local institutional protocols.
## Dose Adjustments
* **Renal Impairment:** Contraindicated in severe renal impairment. Use with extreme caution in mild-to-moderate impairment; monitor creatinine clearance.
* **Hepatic Impairment:** Use with caution; monitor for hepatotoxicity.
* **Elderly:** Use with caution due to the increased risk of anticholinergic side effects (confusion, urinary retention, constipation) from dicyclomine and GI/renal risks associated with NSAIDs.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs (risk of cross-sensitivity).
* Active peptic ulceration or inflammatory bowel disease (IBD).
* Severe renal or hepatic impairment.
* History of GI bleeding or perforation related to NSAID therapy.
* Narrow-angle glaucoma, myasthenia gravis, or obstructive uropathy (due to dicyclomine).
* Coronary artery bypass graft (CABG) surgery (perioperative pain).
## Adverse Effects
* **Mefenamic Acid related:** Gastritis/GI upset, diarrhea, ulceration, bleeding, nephrotoxicity, and increased risk of cardiovascular thrombotic events.
* **Dicyclomine related:** Dry mouth, blurred vision, tachycardia, urinary retention, dizziness, drowsiness, and constipation.
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **SSRIs/Antiplatelets:** Increased risk of GI bleeding.
* **Antihypertensives/Diuretics:** NSAIDs may reduce the efficacy of ACE inhibitors, ARBs, and diuretics; increased risk of nephrotoxicity.
* **CNS Depressants:** Enhanced sedative effects.
* **Potassium-sparing Diuretics:** Increased risk of hyperkalemia.
## Monitoring
* Monitor GI symptoms (bloody/black stools, abdominal pain).
* Assess renal function (BUN/Creatinine) and BP in patients on chronic or frequent dosing.
* Monitor for signs of anticholinergic toxicity (excessive confusion, urinary retention).
## Clinical Pearls
* **Take with food** to mitigate GI irritation from the mefenamic acid component.
* Advise patients to avoid operating heavy machinery if drowsiness occurs due to dicyclomine.
* The mefenamic acid component increases the risk of serious CV thrombotic events, MI, and stroke, which can be fatal.
* This preparation should be avoided in patients with a history of asthma or "aspirin-triad" (aspirin sensitivity, nasal polyps, asthma).
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**Disclaimer:** This information is for educational purposes only. Clinical guidelines and local prescribing formularies vary significantly. Always consult the current product monograph, local drug compendium, or prescribing information before administering medications.
