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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Meclofenamate - Uses, Dose, Side effects, MOA, Brands

A non-steroidal anti-inflammatory medicine (NSAID) called meclofenamate is used to treat mild to moderate pain, inflammation, fever, and arthritis.

Meclofenamate Uss:

Acute gouty arthritis:
- For both short-term and long-term treatment of the signs and symptoms of acute gouty arthritis, meclofenamate is utilised.
Ankylosing spondylitis:
- When used for both acute and chronic ankylosing spondylitis symptoms, it also provide relief.
Arthritis:
- Meclofenamate relieves arthritis symptoms. Relief of signs and symptoms of juvenile arthritis, osteoarthritis, and rheumatoid arthritis are also seen.
Bursitis and tendinitis of the shoulder:
- It is used to treat both acute and chronic signs and symptoms of painful shoulder syndrome (acute subacromial bursitis/suprospinatus tendonitis).
Fever:
- Furthermore, it serves as an antipyretic.
Pain, mild to moderate:
- Mild to moderate pain can also be treated with it.
Primary dysmenorrhea and excessive menstrual blood loss:
- Moreover, it is used to relieve the symptoms and signs of heavy menstrual flow.

Meclofenamate Dose in Adults:

Meclofenamate Dose for treating osteoarthritis and rheumatoid arthritis:

Orally, it can be administered as three to four equally spaced dosages of 200 to 400 mg per day.
Depending on the severity of the condition and the clinical response, it is started at a lower dosage and subsequently increased as necessary.
The daily maximum dose is 400 mg.
The full impact is apparent after two to three weeks.

Meclofenamate Dose for treating mild to moderate Pain:

50 to 100 mg are taken orally every four to six hours.
The daily dosing cap is 400 mg.

Meclofenamate Dose for treating Primary dysmenorrhea and excessive menstrual blood loss:

Starting at the start of menstrual flow, take 100 mg three times each day for up to six days.

Use in Children:

Not indicated.

Pregnancy Risk Factor C

Some studies have shown that NSAIDs can cause in-utero birth defects. However, data from different sources may be inconsistent.
After in utero NSAID treatment, nonteratogenic effects such as prenatal constriction and persistent pulmonary hypertension, oligohydramnios and necrotizing enterocolitis have been observed in the fetus/neonate.
It is also possible to not close the ductus arteriosus after birth. It may be resistant to medical treatment.
Late pregnancy should be avoided because NSAIDs can prematurely close the ductus arteriosus.
Although NSAIDs may be used to treat mild rheumatoid flares in pregnant women, they should be avoided or minimized in the first and third trimesters of pregnancy.
If NSAIDs are used in a prolonged manner in females with reproductive potential, it can lead to infertility. However, the medication can be stopped and the problem can be reversed.
If NSAIDs used in close proximity to the conception, there is a higher chance of miscarriages.

Meclofenamate use during breastfeeding:

It is not known whether breast milk contains it.
After delivery, lactating mothers can use NSAIDs.
Other agents than meclofenamate should be used.
It can also exacerbate thrombocytopenia in breastfeeding mothers.
The continuation of breastfeeding should be evaluated by a doctor for mothers who breastfeed.
The benefits of this treatment should be greater than the risks.

Meclofenamate Dose in Kidney Disease:

Avoid its use in severe renal impairment, however, no particular dose adjustments are given as per the manufacturer's instruction.

KDIGO 2012 guidelines provide the following recommendations for NSAIDs:
- eGFR 30 to <60 mL/minute/1.73 m²:
  - Temporarily discontinue the therapy for patients with intercurrent disease that increases the risk of acute kidney injury.
- eGFR <30 mL/minute/1.73 m²:
  - Avoid use.

Dose in Liver disease:

Caution is advised in chronic liver disease however, no specific dose adjustments are required.

Common Side Effects of Meclofenamate:

Central nervous system:
- Dizziness
Dermatologic:
- Skin rash
Gastrointestinal:
- Abdominal cramps
- Dyspepsia
- Heartburn
- Nausea

Less Common Side Effects of Meclofenamate:

Central nervous system:
- Headache
- Nervousness
Dermatologic:
- Pruritus
Endocrine & metabolic:
- Fluid retention
Gastrointestinal:
- Vomiting
Otic:
- Tinnitus

Contraindications to Meclofenamate:

Hypersensitivity to Meclofenamate can be a serious contraindication. This can occur in patients who have had a history of asthma, urticaria or allergic-type reactions following aspirin use.

Warnings and precautions

Anaphylactoid reactions
- These reactions can happen even in patients who have never had anaphylaxis before.
- They are at higher risk in people with the "aspirin trifecta," also known as Samter's triad (bronchial asthma, aspirin intolerance, and rhinitis).
- It is advised that patients avoid nonsteroidal anti-inflammatory drugs (NSAIDs) if they have bronchospasm or rhinitis after taking them.
Cardiovascular events: [US Boxed Warn]
- NSAIDs can cause potentially fatal cardiovascular effects, including MI and stroke-like symptoms.
- This is because therapy lasts longer.
- Cardiovascular relative risks are the same whether there is a history of previous cardiac disease.
- However, absolute incidence increases in patients with pre-existing heart diseases.
- Exacerbation or new-onset hypertension can occur.
- NSAIDs may also affect the ability to respond to ACE inhibitors or thiazide diuretics.
- It can cause cardiovascular events. It is important to monitor blood pressure.
- It can increase edema, and lead to anasarca.
- Patients with heart failure should not be used.
- Patients with MI should not be used unless the benefits outweigh any potential cardiovascular thrombotic events.
- To reduce cardiovascular events, use the lowest effective dose for the most time.
- Patients at high risk should consider alternate therapies.
- Use the lowest dose possible and for a short time to reduce adverse effects.
CNS effects
- It can lead to blurred vision, drowsiness, dizziness, blurred eyesight, and other neurologic side effect that could impair mental or physical abilities.
- Patients should be cautious about driving, operating machinery or other tasks that require mental alertness.
GI events: [US Boxed Warning]
- NSAIDs increase the risk of serious GI bleeding, ulceration, and perforation that can lead to death.
- Patients over 65 years old and those who have had peptic ulcer disease, GI bleeding or other serious GI issues are at greater risk.
- These events can happen at any moment during therapy, and they are not always predictable.
- Patients with a history or recurrence of severe lower GI bleeding should be advised to stop taking non-aspirin NSAIDs.
- This is especially true if the bleeding is due to diverticulosis or angioectasia.
- If you have had GI ulcers in the past, be cautious.
- Concomitant therapy is known to increase the risk of GI bleeding (eg, aspirin, anticoagulants and/or corticosteroids, selective serotonin reuptake inhibitors), advanced hepatic disease, coagulopathy, smoking, use of alcohol, or in the elderly or debilitated patients.
- Aspirin can be used in conjunction with aspirin to increase the likelihood of GI problems like ulcers. Begin with gastroprotective therapy.
Hematologic effects
- Affected are platelet adhesion, aggregation and both.
- Patients with coagulation disorders and those on anticoagulants should be closely monitored for bleeding.
- Anemia is quite common. Anemia should be checked in patients on long-term NSAID therapy.
- Rarely, severe blood dyscrasias can be caused by NSAIDs. (eg, thrombocytopenia and agranulocytosis).
Hepatic effects
- It is possible to develop transaminitis from its use.
- It can cause hepatic dysfunction.
- If you experience any symptoms or clinical signs of hepatic disease, discontinue use immediately.
Hyperkalemia:
- If NSAIDs are used in conjunction with ACE-I, they can cause severe hyperkalemia.
- This risk is also possible in patients with chronic renal disease and diabetes.
Effects on the renal system:
- NSAIDs can cause a decrease in the dose-dependent synthesis prostaglandins.
- A decline in renal function might result from this.
- In actuality, the renal glomerular flow rate falls.
- Individuals who are using diuretics or ACE inhibitors, have hypovolemia, have heart failure, or have poor renal function are more likely to experience renal toxicity.
- Before starting treatment again, the patient must be adequately hydrated.
- Close monitoring of RFTs and patient needs should be taken.
- Long-term NSAID treatment may cause renal papillary necrosis or other injuries.
Reactions to skin:
- NSAIDs can cause severe skin adverse reactions that could lead to death, including exfoliative dermatitis (SJS), Stevens-Johnson syndrome and toxic epidermal necrolysis.
- It may happen without warning. It is best to stop using it immediately you notice a skin rash.
Asthma
- Patients with asthma that is sensitive to aspirin should not use it. It can lead to severe and possibly fatal bronchospasm.
- Other forms of asthma require caution.
Bariatric surgery
- Gastric ulceration: It is important to avoid the use of non-selective oral NSAIDs for long periods after bariatric surgery.
- It may lead to recurrences of severe GI ulcerations.
- As part of a multimodal pain management strategy, short-term celecoxib and IV ketorolac are recommended.
Coronary bypass surgery for coronary artery bypass: [US Boxed Warn]
- In the case of coronary bypass graft (CABG), surgery, it is not recommended to use.
- There is a possibility of stroke and MI.
Hepatic impairment
- Patients with hepatic impairment should be cautious.
- Patients suffering from advanced hepatic diseases are more at risk for GI bleeding when they use NSAIDs.
Renal impairment
- It is important to exercise caution when dealing with kidney disease.
- Pay attention to RFTs.
- If you experience any systemic manifestations or clinical signs of renal impairment, discontinue using this medication.

Meclofenamate: Drug Interaction

Risk Factor C (Monitor therapy)
5-Aminosalicylic Acid Derivatives	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives.
Acalabrutinib	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.
Alcohol (Ethyl	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination.
Aliskiren	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction.
Aminoglycosides	Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants.
Aminolevulinic Acid (Topical)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical).
Angiotensin II Receptor Blockers	May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function.
Angiotensin-Converting Enzyme Inhibitors	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors.
Anticoagulants	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.
Beta-Blockers	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Beta-Blockers. Exceptions: Levobunolol; Metipranolol.
Bisphosphonate Derivatives	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern.
Cephalothin	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.
Collagenase (Systemic)	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.
Corticosteroids (Systemic	May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents (Nonselective).
Dasatinib	May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Deferasirox	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.
Deoxycholic Acid	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.
Desmopressin	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Desmopressin.
Digoxin	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin.
Drospirenone	Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Drospirenone.
Eplerenone	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone.
Fat Emulsion (Fish Oil Based	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Felbinac	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Glucosamine	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Haloperidol	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion.
HydrALAZINE	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE.
Ibritumomab Tiuxetan	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.
Ibrutinib	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Inotersen	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Limaprost	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
MetFORMIN	Nonsteroidal Anti-Inflammatory Drugs may intensify MetFORMIN's harmful or hazardous effects.
Multivitamins/Fluoride (with ADE)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with ADEK, Folate, Iron	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with AE, No Iron	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Naftazone	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents.
Nalmefene	The serum concentration of Nalmefene may rise when meclofenamate is present.
Obinutuzumab	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.
Omega-3 Fatty Acids	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Pentosan Polysulfate Sodium	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.
Pentoxifylline	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Porfimer	Photosensitizing Agents may enhance the photosensitizing effect of Porfimer.
Potassium-Sparing Diuretics	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics.
PRALAtrexate	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Closely monitor for increased pralatrexate serum levels and/or toxicity if used concomitantly with an NSAID. Monitor for decreased pralatrexate serum levels with NSAID discontinuation.
Probenecid	May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents.
Prostacyclin Analogues	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Prostaglandins (Ophthalmic)	Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic).
Quinolones	Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones.
Salicylates	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Serotonin/Norepinephrine Reuptake Inhibitors	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Tacrolimus (Systemic)	Nonsteroidal Anti-Inflammatory Drugs may intensify Tacrolimus' nephrotoxic effects (Systemic).
Thiazide and Thiazide-Like Diuretics	May enhance the nephrotoxic effect of Nonsteroidal AntiInflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics.
Thrombolytic Agents	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.
Tipranavir	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Tolperisone	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents.
Tricyclic Antidepressants (Tertiary Amine	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Vancomycin	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin.
Verteporfin	Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin.
Vitamin E (Systemic)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Zanubrutinib	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Risk Factor D (Consider therapy modification)
Apixaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of apixaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Bemiparin	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin and nonsteroidal anti-inflammatory agents (NSAIDs) due to the increased risk of bleeding. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.
Bemiparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.
Bile Acid Sequestrants	May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents.
CycloSPORINE (Systemic)	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs.
Dabigatran Etexilate	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Diclofenac (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Seek alternatives to the combined use of diclofenac with other nonsteroidal anti-inflammatory agents (NSAIDs). Avoid the use of diclofenac/misoprostol with other NSAIDs.
Edoxaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Enoxaparin	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue nonsteroidal anti-inflammatory agents (NSAIDs) prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.
Enoxaparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.
Heparin	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required.
Heparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Management: Concomitant treatment with these agents should generally be avoided. If used concomitantly, increased diligence in monitoring for adverse effects (eg, bleeding, bruising, altered mental status due to CNS bleeds) must be employed.
Lithium	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium.
Loop Diuretics	Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended.
Methotrexate	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Alternative anti-inflammatory therapy should be considered whenever possible, especially if the patient is receiving higher, antineoplastic doses of methotrexate.
Rivaroxaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Salicylates	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Exceptions: Choline Magnesium Trisalicylate.
Selective Serotonin Reuptake Inhibitors	May enhance the antiplatelet effect of Nonsteroidal AntiInflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk.
Sincalide	Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction.
Sodium Phosphates	May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely.
Tenofovir Products	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose.
Vitamin K Antagonists (eg, warfarin)	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor coagulation status closely and advise patients to promptly report any evidence of bleeding or bruising.
Risk Factor X (Avoid combination)
Acemetacin	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Aminolevulinic Acid (Systemic)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic).
Dexibuprofen	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Dexibuprofen.
Dexketoprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Floctafenine	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Ketorolac (Nasal)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Ketorolac (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Macimorelin	Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin.
Mifamurtide	Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide.
Morniflumate	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective).
Omacetaxine	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs) with omacetaxine in patients with a platelet count of less than 50,000/uL.
Pelubiprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Phenylbutazone	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Talniflumate	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Tenoxicam	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Urokinase	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.
Zaltoprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Monitoring parameters:

CBC.
chemistry profile.
occult blood loss.
periodic liver function tests.
renal function (urine output, serum BUN and creatinine).
signs or symptoms of GI bleeding.
blood pressure

How to administer Meclofenamate?

To minimise side effects, take the medication with food or milk.

Mechanism of action of Meclofenamate:

Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties.
Other proposed mechanisms not fully elucidated (and possibly contributing to the anti-inflammatory effect to varying degrees) include inhibiting chemotaxis, altering lymphocyte activity, inhibiting neutrophil aggregation/activation, and decreasing proinflammatory cytokine levels.

Duration:

2 to 4 hours

Protein binding:

>99%

Metabolism:

Metabolized to metabolite I (active) and ~6 other minor metabolites

Bioavailability:

100%

Half-life elimination:

Meclofenamate sodium: 0.8 to 2.1 hours;
Metabolite I: ~15 hours

Time to peak serum concentration:

Meclofenamate sodium: 0.5 to 2 hours;
Metabolites: 0.5 to 4 hours

Excretion:

Primarily urine (70%; primarily as metabolites);
feces (30%)

International Brand Names of Meclofenamate:

Eucome
Geonan
Meclomen
Medomen
Melvon

Meclofenamate Brand Names in Pakistan:

No Brands Available in Pakistan.

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Meclofenamate - Uses, Dose, Side effects, MOA, Brands

Meclofenamate Uss:

Acute gouty arthritis:

Ankylosing spondylitis:

Arthritis:

Bursitis and tendinitis of the shoulder:

Fever:

Pain, mild to moderate:

Primary dysmenorrhea and excessive menstrual blood loss:

Meclofenamate Dose in Adults:

Meclofenamate Dose for treating osteoarthritis and rheumatoid arthritis:

Meclofenamate Dose for treating mild to moderate Pain:

Meclofenamate Dose for treating Primary dysmenorrhea and excessive menstrual blood loss:

Use in Children:

Pregnancy Risk Factor C

Meclofenamate use during breastfeeding:

Meclofenamate Dose in Kidney Disease:

Dose in Liver disease:

Common Side Effects of Meclofenamate:

Central nervous system:

Dermatologic:

Gastrointestinal:

Less Common Side Effects of Meclofenamate:

Central nervous system:

Dermatologic:

Endocrine & metabolic:

Gastrointestinal:

Otic:

Contraindications to Meclofenamate:

Warnings and precautions

Anaphylactoid reactions

Cardiovascular events: [US Boxed Warn]

CNS effects

GI events: [US Boxed Warning]

Hematologic effects

Hepatic effects

Hyperkalemia:

Effects on the renal system:

Reactions to skin:

Asthma

Bariatric surgery

Coronary bypass surgery for coronary artery bypass: [US Boxed Warn]

Hepatic impairment

Renal impairment

Monitoring parameters:

How to administer Meclofenamate?

Mechanism of action of Meclofenamate:

International Brand Names of Meclofenamate:

Meclofenamate Brand Names in Pakistan:

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