Meftal Spas: Uses, How It Works, Side Effects

What is Meftal Spas used for?

Meftal Spas is used to relieve cramping pain, especially period pain and spasm-type pain in the abdomen.

• Period pain (dysmenorrhoea), including cramps in the lower tummy and lower back
• Abdominal cramps and colicky pain caused by spasm of the stomach and intestine muscles
• Cramping tummy pain linked to irritable bowel syndrome (IBS), when a doctor advises it

How does Meftal Spas work?

Meftal Spas works in two ways. Mefenamic acid blocks enzymes called cyclo-oxygenases (COX-1 and COX-2), which make prostaglandins. Prostaglandins make the womb squeeze hard during a period and make nerves more sensitive to pain, so lowering them eases cramps and pain. Dicyclomine is an antispasmodic. It blocks acetylcholine, a nerve messenger that tells the smooth muscle of the gut to contract, and it also relaxes the muscle directly, which calms painful spasm.

What happens in your body after you take it

1. You swallow the tablet

   Taken with or after food, the tablet breaks apart in the stomach and releases both medicines. Food helps protect the stomach lining from irritation by mefenamic acid.

2. Both medicines are absorbed

   The two medicines pass from the gut into the blood. Dicyclomine is absorbed quickly and reaches its highest level in about 60 to 90 minutes. Mefenamic acid reaches its highest level in about 2 to 4 hours, and most of it travels in the blood attached to proteins.

3. Mefenamic acid blocks COX enzymes

   Throughout the body, mefenamic acid blocks the COX-1 and COX-2 enzymes. These enzymes turn a fatty acid in cell walls into prostaglandins, chemical messengers that cause pain, swelling and muscle tightening.

4. Period cramps ease

   Just before and during a period, the lining of the womb releases a lot of prostaglandins. They make the womb muscle contract strongly, which squeezes its blood supply and causes cramping pain. With fewer prostaglandins, the contractions are weaker, nerves are less sensitive, and the pain eases.

5. Dicyclomine relaxes gut spasm

   Dicyclomine attaches to muscarinic receptors on the smooth muscle of the stomach and intestines. This stops acetylcholine from signalling the muscle to contract. Dicyclomine also has a direct relaxing effect on the muscle, so painful spasms and colicky cramps settle.

6. The same actions explain the side effects

   Prostaglandins made by COX-1 also protect the stomach lining and keep blood flowing to the kidneys, so blocking them can irritate the stomach and strain the kidneys. Dicyclomine also blocks acetylcholine in the salivary glands, eyes, bladder and sweat glands, causing dry mouth, blurred vision, difficulty passing urine and less sweating.

7. The liver and kidneys clear it

   The liver changes mefenamic acid, mainly through an enzyme called CYP2C9, into inactive forms, and about half of each dose leaves in the urine. Dicyclomine is removed mostly in the urine. Each medicine has a half-life of about 2 hours, so the effect fades over several hours.

How to take Meftal Spas

Take Meftal Spas exactly as your doctor advises or as printed on the pack. Do not take more, more often, or for longer than directed.

• Take it with or just after food, with a glass of water, to lower the chance of stomach upset.
• It is meant for short courses. For period pain it is usually taken only on the days the pain is present, starting when the pain or bleeding begins.
• Use the lowest dose that works for the shortest time. Do not take it regularly for weeks without a doctor's review.
• Do not take it together with other NSAID painkillers such as ibuprofen, diclofenac, aceclofenac, naproxen or aspirin, or with another medicine that contains mefenamic acid or dicyclomine. Check the labels of combination products.
• Stop taking it and talk to a doctor if you get diarrhoea or a skin rash.
• Meftal Spas tablets are not meant for children. Products for children have a different formula and should be given only on a doctor's advice.
• See a doctor if period pain is severe, getting worse or not relieved, or if tummy pain is sudden, severe, or comes with fever, vomiting or blood in the stools.

Side effects of Meftal Spas

Many people who take Meftal Spas for a short time have no or only mild side effects. The mefenamic acid part can irritate the stomach, and the dicyclomine part can cause effects such as dry mouth and dizziness. You can report side effects to the Pharmacovigilance Programme of India helpline, 1800-180-3024.

Uncommon or mild

• Dry mouth and thirst
• Dizziness, drowsiness or tiredness
• Blurred vision
• Nausea, indigestion, heartburn or tummy pain
• Constipation
• Diarrhoea (stop the medicine and tell your doctor if this happens)
• Headache

Who should be careful

Meftal Spas is not suitable for everyone. Check with a doctor before taking it if any of the following apply to you.

• A stomach ulcer or stomach bleeding now or in the past, or inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Asthma, especially if aspirin or other painkillers have made your breathing worse, or a past allergy to any NSAID
• Kidney, liver or heart disease, high blood pressure, a past heart attack or stroke, or recent heart bypass surgery
• Glaucoma (raised pressure in the eye), an enlarged prostate or difficulty passing urine: dicyclomine can make these worse, and the medicine is generally not suitable
• Myasthenia gravis, a blockage in the gut, or reflux with inflammation of the food pipe
• Age over 65: a higher chance of stomach bleeding, kidney problems and confusion
• Pregnancy: NSAIDs such as mefenamic acid are generally avoided from about 20 weeks of pregnancy and must not be used in the last 3 months. Earlier in pregnancy, use it only if a doctor advises it
• Breastfeeding: not usually recommended, because dicyclomine passes into breast milk and young babies are sensitive to it
• Hot weather or hard physical work: dicyclomine reduces sweating, which raises the risk of overheating and heat stroke
• Driving or using machines: it can cause drowsiness, dizziness or blurred vision
• Children: Meftal Spas tablets are not meant for children

Medicines and things that interact with Meftal Spas

Meftal Spas can interact with several medicines. Tell your doctor or pharmacist about everything you take, including painkillers bought without a prescription.

• Other NSAIDs, including ibuprofen (also in Combiflam), diclofenac, aceclofenac, naproxen and aspirin: higher risk of stomach ulcers and bleeding
• Blood thinners such as warfarin, and antiplatelet medicines such as clopidogrel or low-dose aspirin: higher risk of bleeding
• Antidepressants such as fluoxetine, sertraline, escitalopram (SSRIs) or venlafaxine (SNRIs): higher risk of stomach bleeding
• Steroid tablets such as prednisolone: higher risk of stomach ulcers and bleeding
• Lithium and methotrexate: their levels in the blood can rise to harmful levels
• Blood pressure medicines such as ACE inhibitors (for example ramipril), ARBs (for example telmisartan) and diuretics (water tablets): they may work less well, and the kidneys can be harmed, especially if you are dehydrated
• Digoxin (a heart medicine): its level in the blood can rise
• Other medicines with anticholinergic effects, such as some antihistamines, tricyclic antidepressants (for example amitriptyline) and antipsychotics: more dry mouth, constipation, blurred vision, drowsiness and confusion
• Metoclopramide and domperidone (for nausea): dicyclomine works against their effect on the gut
• Antacids: those containing magnesium hydroxide can increase the absorption of mefenamic acid, and antacids can reduce the absorption of dicyclomine. Ask a pharmacist how to space the doses
• Quinolone antibiotics such as ciprofloxacin: NSAIDs may increase the risk of fits
• Alcohol: increases the risk of stomach bleeding and makes drowsiness worse

If someone takes too much

Storage

Store below 30°C in a dry place, away from direct light, and out of the reach of children. Do not use after the expiry date.

Regulatory status in India

Prescription medicine sold in India. The two-ingredient combination of mefenamic acid and dicyclomine is not on the CDSCO list of prohibited medicines and was not among the 156 fixed-dose combinations banned in August 2024, although some other combinations containing mefenamic acid or dicyclomine have been banned. In November 2023 the Indian Pharmacopoeia Commission issued a drug safety alert asking doctors and patients to watch for a rare reaction called DRESS with mefenamic acid. This was a monitoring alert, not a ban.

Other brands with the same medicine

Other brands with the same two ingredients at the same strength (mefenamic acid 250 mg + dicyclomine 10 mg) include Almefkem Spas, Cyclopam-MF, Mifer Spas and Spasmonil Plus. They work the same way. Meftal-Spas DS contains twice the amount of both ingredients, and Meftal-Spas drops and suspension for children are a different formula (dicyclomine with simethicone, without mefenamic acid). Check the label for the ingredients and strength.

Common questions