MEFCID Tablet

Mild to moderate pain including muscular, traumatic and dental pain, headaches of most aetiology, postoperative and post-partum pain, pyrexia in children. Dysmenorrhea.

Mild to moderate pain in rheumatoid arthritis (including Still’s Disease) and osteoarthrosis.

Menorrhagia due to dysfunctional causes ad presence of an IUD when other pelvic pathology has been ruled out.

Dosage

Usual adult dose:

Analgesic or Antidysmenorrheal - 500mg, 3 times a day initially, followed by 250mg every 6 hours as needed.

Note: It is recommended that mefenamic acid be used for no longer than 7 days at a time.

Usual pediatric use:

Children up to 14 years of age - Safety and efficacy have not been established.

Additional dosing information: It is recommended that mefenamic acid therapy be discontinued promptly if diarrhea or a skin rash develops. Patients who develop diarrhea during mefenamic acid therapy are usually unable to tolerate the drug there after.

Inflammatory bowel disease

Peptic and/or intestinal ulceration

Renal and hepatic impairment

Asthma

The commonest adverse effects occurring with mefenamic acid are gastro-intestinal disturbances including diarrhoea. Peptic ulceration and gastro-intestinal bleeding have also been reported. Headache, drowsiness and dizziness have been reported. There may be hypersensitivity reactions including skin rashes and urticaria, and occasionally allergic glomerulonephritis; asthma may be precipitated. Reported haematological effects include haemolytic anaemia, agranulocytosis, pancytopenia and thrombocytopenia. Renal failure, glomerulonephritis and papillary necrosis have been reported.

Therapy should be discontinued if diarrhoea or skin rash occur. Bronchospasm may be precipitated in patients suffering from, or with a previous history of, bronchial asthma or allergic disease.

Slight potentiation of oral anticoagulants is well documented, but this is rarely significant. When the drug is administered to patients receiving oral anticoagulant drugs, monitoring of prothrombin time as clinically indicated is necessary.

Pregnancy

The safety of mefenamic acid in pregnancy has not been established.

Breast milk

Very small amounts enter breast milk and may be transmitted to infants of nursing mothers.

RISK OF GI ULCERTIONS, BLEEDING ND PERFORATION WITH NSAID:

Serious GI toxicity, such as bleeding, ulceration and perforation can occur at any time, with or without warning symptoms, in patients treated with NSAID therapy. Although minor upper GI problems (e.g. dyspepsia) are common, usually developing early in therapy, prescribes should remain alert for ulceration and bleeding in patients treated with NSAIDs even in the absence of previous GI tract symptoms.

Studies to date have not identified any subset of patients not at risk of developing peptic ulceration and bleeding. Patients with prior history of serious adverse events and other risk factors associated with peptic ulcer disease (e.g. alcoholism, smoking and corticosteroid therapy) are at increased risk.

Elderly or debilitated patients seem to tolerate ulceration or bleeding less well than other individuals and account for most spontaneous reports for fatal GI events.

In patients suffering from dehydration and renal disease, particularly the elderly, concurrent therapy with other plasma protein binding drugs may necessitate a modification in dosage.

Mefenamic acid is an analgesic with anti-inflammatory properties, and a demonstrable antipyretic effect.

NSAIDs inhibit the activity of the enzyme cyclo-oxygenase, resulting in decreased formation of precursors of prostaglandins and thromboxanes from arachidonic acid. Although the resultant decrease in prostaglandin synthesis and activity in various tissues may be responsible for many of the therapeutic (and adverse) effects of NSAIDs, other actions may also contribute significantly to the therapeutic effects of these medications.

Analgesic

May block pain impulse generation via a peripheral action that may involve reduction of the activity of prostaglandins, and possibly inhibition of the synthesis or actions of other substances that sensitize pain receptors to mechanical or chemical stimulation.

Antidysmenorrheal

By inhibiting the synthesis and activity of intrauterine prostaglandins (which are thought to be responsible for the pain and other symptoms of primary dysmenorrhea), NSAIDs decrease uterine contractility and uterine pressure, increase uterine perfusion, and relieve ischemic as well as spasmodic pain. Also, NSAIDs may relieve to some extent extraulerine symptoms (such as headache, nausea, and vomiting) that may be associated with excessive prostaglandin production.

Vascular headache prophylactic and suppressant

Analgesic actions may be involved in relief of headache. Also, by reducing prostaglandin activity, NSAIDs may directly prevent or relieve certain types of headache thought to be caused by prostaglandin-induced dilation or constriction of cerebral blood vessels.