Mefenamic acid (Ponstan) is a non-selective COX-1 and COX-2 inhibitor that is used to relieve pain, inflammation, and fever.
Mefenamic acid (Ponstan) Uses:
-
Pain, mild to moderate:
- When therapy is limited to one week and the patient is older than 14 years old, it functions as a pain reliever.
-
Primary dysmenorrhea:
- The therapy of primary dysmenorrhea is also indicated.
Mefenamic acid (Ponstan) Dose in Adults:
Note: Use the lowest effective dose for the shortest possible duration.
Mefenamic acid (Ponstan) Dose in the treatment of Pain, mild to moderate:
- Oral: Initial: 500 mg, followed by 250 mg every six hours as necessary; often no longer than one week.
Mefenamic acid (Ponstan) Dose in the treatment of Primary dysmenorrhea:
- Oral: Initial: 250 mg every 6 hours (per the manufacturer's labelling) or 500 mg three times daily (Delgado 1994; De Mello 2004; Langrick 1989), starting at 500 mg at the first sign of bleeding and the accompanying symptoms, with a maximum treatment period of three days.
Use in Children:
Not indicated.
Mefenamic acid (Ponstan) Pregnancy Risk Category: C (D in the third trimester)
- It can also cross the placental boundary.
- Some studies have shown that birth defects can be caused by in utero NSAID use. However, the data is inconsistent.
- In utero NSAIDs have been shown to cause nonteratogenic effects in the fetus/neonate, such as prenatal constriction and persistent pulmonary hypertension, oligohydramnios and necrotizing enterocolitis.
- Additionally, postnatal non-closure of ductus arteriosus may occur. This can be difficult to manage medically.
- Avoid using NSAIDs during pregnancy. They can cause premature closure of ductus arteriosus.
- The long-term use of it can cause infertility in women of childbearing years. However, this can be reversed by stopping the therapy.
- It should be avoided by women who are having trouble conceiving and those who are undergoing fertility treatment.
- The product of conception may experience miscarriage if NSAIDs are used close to the time of conception.
Mefenamic acid use during breastfeeding:
- Breast milk may contain mefenamic acid.
- Based on the highest concentration of breast milk, the relative infant dose (RID), of mefenamic acids is 0.92%.
- This is when it's compared to a maternal weight-adjusted dose of 750mg/day.
- RID 10% is generally acceptable for breastfeeding, while RID 25% should be avoided.
- The highest possible milk concentration (0.66 mg/mL) is used to calculate the daily infant dose via breastmilk at 0.099 mg/kg/day.
- The milk concentration was determined after maternal administration of oral mefenamic Acid 500 mg and 250 mg three times per day. Samples were taken on days 2 through 4.
- We can detect mefenamic acids in the urine and serum of breastfeeding infants.
- NSAIDs can be used by postpartum mothers who want to breastfeed.
- However, other agents than mefenamic acids are preferable (Montgomery 2012).
- Breastfeeding infants with platelet dysfunction and thrombocytopenia should not be allowed to use NSAIDs.
- The manufacturer suggests that the mother decide whether to stop breastfeeding or discontinue using the drug.
- This is in consideration of the possibility of serious adverse reactions in breastfeeding infants.
Ponstan Dose in patients with kidney disease:
- Those with advanced renal illness and those who already have the condition should not use it.
-
KDIGO 2012 guidelines provide the following recommendations for NSAIDs:
- eGFR 30 to <60 mL/minute/1.73 m²:
- Temporarily discontinue in patients with intercurrent disease that increases the risk of acute kidney injury.
- eGFR <30 mL/minute/1.73 m²:
- Avoid use.
- eGFR 30 to <60 mL/minute/1.73 m²:
Ponstan Dose in patients with Liver disease:
- The manufacturer's labelling (which has not been examined) does not mention dosage changes, but given the significant hepatic metabolism, one may be required.
Side Effects of Mefenamic acid (Ponstan):
-
Central nervous system:
- Dizziness
- Headache
- Nervousness
-
Dermatologic:
- Pruritus
- Skin rash
-
Endocrine & metabolic:
- Fluid retention
-
Gastrointestinal:
- Abdominal cramps
- Abdominal distress
- Abdominal pain
- Constipation, diarrhea
- Duodenal ulcer (with bleeding or perforation)
- Dyspepsia
- Flatulence
- Gastric ulcer (with bleeding or perforation)
- Gastritis
- Heartburn
- Nausea
- Vomiting
-
Hematologic & oncologic:
- Hemorrhage
-
Hepatic:
- may increase liver enzymes
-
Otic:
- Tinnitus
Contraindications to Mefenamic acid (Ponstan):
- Mefenamic Acid is not recommended if you are allergic to it or any other component of the formulation.
- For the therapy of coronary bypass graft surgery, it is not advised (CABG).
- Individuals who have a history of allergic responses of any kind to aspirin or other NSAIDs, urticaria, or asthma.
Canadian labeling: Additional contraindications (not in US labeling).
- Pregnancy in the third trimester
- Breast-feeding
- Grave uncontrolled heart disease;
- Active gastric, duodenal or peptic ulcer
- active gastrointestinal bleeding;
- cerebrovascular bleeding and other bleeding disorders
- Inflammatory bowel disease
- severe hepatic impairment, active hepatic diseases
- Grave renal impairment (CrCl 30 mg/minute) or deteriorating kidney disease
- Hyperkalemia is a known condition.
- Adolescents 18 and under
Warnings and precautions
-
Anaphylactoid reactions
- Anaphylactoid reactions can occur even in patients who have never been exposed to anaphylactic substances.
- Patients with the "aspirin trifecta" (bronchial asthma and aspirin intolerance, rhinitis) could be at higher risk.
- Contraindicated in patients with bronchospasm, asthma, rhinitis, or urticaria with NSAID or aspirin therapy.
-
Cardiovascular events: [US Boxed Warn]
- NSAIDs can increase the risk of severe (and possibly fatal) adverse cardiovascular thrombotic conditions, such as stroke and myocardial damage.
- This risk can occur during treatment, and it may increase as the use continues.
- The relative risk seems to be the same in people with and without cardiovascular disease, or risk factors for it.
- However, absolute cardiovascular thrombotic events may occur earlier in treatment in those who have known cardiovascular disease and those who are at higher risk.
- Exacerbation or new-onset hypertension can occur. NSAIDs could also impair the response to ACE inhibitors, thiazide or loop diuretics; may lead to cardiovascular events.
- It may cause fluid retention and sodium buildup; take extra care with edematic patients.
- Do not give to patients with heart failure.
- If there are any cardiovascular thrombotic risks, do not give this medication to patients who have had a recent myocardial injury.
- To reduce your risk of developing cardiovascular events, use the lowest effective dose for the shortest time. This is consistent with the individual patient's goals.
- Alternate therapy is recommended for high-risk patients.
-
CNS effects
- This may cause blurred vision, drowsiness, or dizziness.
- Encourage patients to pay attention when performing tasks that require mental alertness (eg driving or operating machinery)
-
GI events: [US Boxed Warning]
- NSAIDs increase the risk of severe GI inflammation, ulceration and bleeding (may be fatal); patients older than 65 years old and those with a history peptic ulcer disease or GI bleeding are more at risk.
- These events can occur without warning and at any time during therapy.
- It should be avoided when there is active bleeding.
- Avoid non-aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) for patients who have had a history or experience of severe lower gastrointestinal bleeding.
- Use caution with a history of gastrointestinal ulcers, concurrent therapy 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.
- To reduce the chance of complications, use the lowest effective dose for the most time.
- This is consistent with the individual patient's goals. Alternate therapies should be considered in high-risk patients.
- Concomitant use of aspirin can lead to a significant increase in the risk for gastrointestinal complications (eg ulcers).
- Therefore, concomitant gastroprotective treatment (eg proton pump inhibitors), is highly recommended (Bhatt, 2008).
-
Hematologic effects
- The functions of platelets such as adhesion or aggregation can be reduced; bleeding time may increase; patients with coagulation problems or those who are on anticoagulants need to be closely monitored.
- Anemia can occur. Patients on long-term NSAID therapy need to be closely monitored.
- Rarely, NSAIDs have been linked to severe blood dyscrasias, such as thrombocytopenia, agranulocytosis and aplastic anemia.
-
Hepatic effects
- Transaminase levels rise with its use; closely monitor patients who have abnormal LFT.
- Rare but sometimes fatal hepatic reactions have been linked to NSAIDs.
- If you notice any signs or symptoms of hepatic diseases, or if there are systemic manifestations, stop taking the medication immediately.
-
Hyperkalemia:
- NSAIDs can increase hyperkalemia risk, especially in elderly people, diabetics, and those who use concomitantly with other agents that induce hyperkalemia (eg ACE-inhibitors).
- Hyperkalemia can have fatal consequences, so it is important to monitor potassium levels.
-
Effects on the renal system:
- NSAIDs can affect renal function. Dose-dependent decreases of prostaglandin synthesis could be caused by NSAIDs.
- This could decrease renal blood flow and result in renal decompensation (usually reversible).
- Renal toxicity is more likely to occur in patients with poor renal function, dehydration and hypovolemia, cardiac disease, hepatic impairment, diuretics, ACE inhibitors, or elderly patients.
- Make sure the patient has enough water before you begin therapy. Keep an eye on your renal function as well.
- Long-term NSAID abuse can cause renal injury that could lead to renal papillary necrosis.
-
Reactions to skin:
- NSAIDs can have severe dermatologic effects and may lead to potentially fatal skin adverse reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis, and exfoliative dermatitis (TEN). These events may not be a warning sign.
- Stop using the product immediately you notice a skin rash or other signs of hypersensitivity.
-
Asthma
- Patients with asthma that is aspirin-sensitive should not use this product. Bronchospasm can be severe and possibly fatal.
- Take extra care when treating other types of asthmatic patients.
-
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.
- Following CABG surgery, the risk of stroke and myocardial damage may increase.
-
Hepatic impairment
- Patients with impaired liver function should be cautious; dosage adjustments may need to be made due to a high level of hepatic metabolism.
- Patients suffering from advanced hepatic diseases are more at risk for gastrointestinal bleeding when they take NSAIDs.
-
Renal impairment
- Patients with pre-existing renal disease or advanced renal disease should not be given this medication. If therapy is necessary, it is important to monitor the renal function.
Mefenamic acid: Drug Interaction
|
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 |
|
|
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 Agents may enhance the adverse/toxic effect of MetFORMIN. |
|
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. |
|
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 Agents may enhance the nephrotoxic effect of Tacrolimus (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 gastrointestinal bleeding;
- blood pressure.
How to administer Mefenamic acid (Ponstan)?
Can be taken with food, milk, or antacids.
Mechanism of action of Mefenamic acid (Ponstan):
- It reverses the inhibition of cyclooxygenase-1 (COX-1) enzymes.
- This results in decreased production of prostaglandin precursors.
- It is an antipyretic, analgesic and anti-inflammatory agent.
- 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.
Absorption:
- Rapidly absorbed
Protein binding:
- >90% to albumin
Metabolism:
- Hepatic via CYP2C9 to metabolites (activity not known)
Half-life elimination:
- About 2 hours
Time to peak:
- 2 to 4 hours
Excretion:
- Urine (~52%) and feces (~20%) as unchanged drug and metabolites
International Brand Names of Mefenamic acid:
- Ponstel
- DOM-Mefenamic Acid
- PMS-Mefenamic Acid
- Ponstan
- Afloxan
- Alfoxan
- Alfoxid
- Algex
- Algifort
- Allogon
- Amifen
- Analspec
- Asmef
- Atmose
- Beafemic
- Betamef
- Coly
- Conamic
- Coslan
- Datan Forte
- Dolor
- Dolostan
- Dysmen
- Ecopan
- Fenagesic
- Fenam
- Fenamic
- Fenamin
- Fenamol
- Fendol
- Fendol DS
- Gandin
- Gandin DS
- Gardan
- Hispen
- Hostan
- Inflasic
- Johnstal
- Konafen
- Lysalgo
- Manic
- Manomic
- Mecid A
- Mefac
- Mefacit
- Mefcid
- Mefen
- Mefenamynka
- Mefepain
- Mefex
- Nam
- Namic
- Napan
- Nichostan
- Painnox
- Painstop
- Parkemed
- Passton
- Pehastan
- Poncofen
- Pondex
- Pondnadysmen
- Ponmel
- Pono
- Ponser
- Ponstan
- Ponstan Forte
- Ponstan-500
- Ponstil
- Ponstyl
- Pontacid
- Pontal
- Pontalon
- Potarlon
- Ralgec
- Sefmic
- Shanamef
- Sicadol
- Solasic
- Spegic Forte
- Tanston
- Varistan
- Vidan
Mefenamic acid Brand Names in Pakistan:
Mefenamic Acid Suspension 50 mg/5ml in Pakistan |
|
| Kohimax | Kohs Pharmaceuticals |
| Mefcid | Miracle Pharmaceuticals(Pvt) Ltd |
| Mefco | Eros Pharmaceuticals |
| Meftac | Alina Combine Pharmaceuticals (Pvt) Ltd. |
| Solacy | Maple Pharmaceuticals (Pvt) Ltd |
| Staifamine | Standard Drug Co. |
| Unimef | Universal Pharmaceuticals (Pvt) Ltd |
Mefenamic Acid Suspension 100 mg/5ml in Pakistan |
|
| Ponsic Fort | Safe Pharmaceutical (Pvt) Ltd. |
Mefenamic Acid Suspension 50 mg/5ml |
|
| Acimef | Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
| Acimef | Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
| Amic | Libra Pharmaceuticals (Pvt) Ltd |
| Amnic | Jawa Pharmaceuticals(Pvt) Ltd. |
| Amnic | Jawa Pharmaceuticals(Pvt) Ltd. |
| Deemac | Delux Chemical Industries |
| Delmic | Delta Pharma (Pvt) Ltd. |
| Dologin | Opal Laboratories (Pvt) Ltd. |
| Dolor | Adamjee Pharmaceuticals (Pvt) Ltd. |
| Epostan | Epoch Pharmaceutical |
| Epostan | Epoch Pharmaceutical |
| Fengesic | Werrick Pharmaceuticals |
| Gardan | Sanofi Aventis (Pakistan) Ltd. |
| Kaypan | Karachi Chemical Industries |
| Mafic | Nova Med Pharmaceuticals |
| Martan | Marvi Laboratories |
| Mb-Stan | Multinational Buisness Link |
| Mefescot | Scotmann Pharmaceuticals |
| Meflin | Harmann Pharmaceutical Laboratories (Pvt) Ltd. |
| Meflin | Harmann Pharmaceutical Laboratories (Pvt) Ltd. |
| Mefnac | Efroze Chemical Industries (Pvt) Ltd. |
| Mefnacin | Hizat Pharmaceutical Industries (Pvt) Ltd. |
| Mefomide | Swiss Pharmaceuticals (Pvt) Ltd. |
| Menamic | Munawar Pharma (Pvt) Ltd. |
| Menamic | Munawar Pharma (Pvt) Ltd. |
| Mepon | Ferozsons Laboratoies Ltd. |
| Neomef | Neo Medix |
| Painton | Alliance Pharmaceuticals (Pvt) Ltd. |
| Panamaz | Hamaz Pharmaceutical (Pvt) Ltd. |
| Panamic | Lisko Pakistan (Pvt) Ltd |
| Ponfab | Askari Pharmaceuticals. |
| Ponsac | Brookes Pharmaceutical Laboratories (Pak.) Ltd. |
| Ponsic | Safe Pharmaceutical (Pvt) Ltd. |
| Ponsic | Safe Pharmaceutical (Pvt) Ltd. |
| Ponstan | Pfizer Laboratories Ltd. |
| Regocid | Regent Laboratories Ltd. |
| Regocid | Regent Laboratories Ltd. |
| Resti | Neutro Pharma (Pvt) Ltd. |
| Syngesic | Synchro Pharmaceuticals |
| Unistan | Tg Pharma |
Mefenamic Acid Suspension 100 mg/5ml in Pakistan |
|
| Delmic Forte | Delta Pharma (Pvt) Ltd. |
| Dologin | Opal Laboratories (Pvt) Ltd. |
| Dolor | Adamjee Pharmaceuticals (Pvt) Ltd. |
Mefenamic Acid Suspension 250 mg/5ml in Pakistan |
|
| Nivastan | Polyfine Chempharma (Pvt) Ltd. |
Mefenamic Acid Tablets 250 Mg in Pakistan |
|
| A-Pnamic | Pulse Pharmaceuticals |
| Aafia | Maple Pharmaceuticals (Pvt) Ltd |
| Almef | Alson Pharmaceuticals |
| Amic | Libra Pharmaceuticals (Pvt) Ltd |
| Amnic | Jawa Pharmaceuticals(Pvt) Ltd. |
| Amnic | Jawa Pharmaceuticals(Pvt) Ltd. |
| Anapan | Star Laboratories (Pvt) Ltd. |
| Austan | Ambrosia Pharmaceuticals |
| Austan | Ambrosia Pharmaceuticals |
| Austan | Ambrosia Pharmaceuticals |
| Befenac | Batala Pharmaceuticals. |
| Befenac | Batala Pharmaceuticals. |
| Befenac | Batala Pharmaceuticals. |
| Boschtan | Bosch Pharmaceuticals (Pvt) Ltd. |
| Ciman | Caraway Pharmaceuticals |
| Ciman | Caraway Pharmaceuticals |
| Ciman | Caraway Pharmaceuticals |
| Davipon | Davis Pharmaceutical Laboratories |
| Deemac | Delux Chemical Industries |
| Deemac | Delux Chemical Industries |
| Deemac | Delux Chemical Industries |
| Delmic | Delta Pharma (Pvt) Ltd. |
| Dologin | Opal Laboratories (Pvt) Ltd. |
| Dolor | Adamjee Pharmaceuticals (Pvt) Ltd. |
| Dolor | Adamjee Pharmaceuticals (Pvt) Ltd. |
| Epostan | Epoch Pharmaceutical |
| Epostan | Epoch Pharmaceutical |
| Febrin | Remington Pharmaceutical Industries (Pvt) Ltd. |
| Febrin | Remington Pharmaceutical Industries (Pvt) Ltd. |
| Fenamic | Unexo Labs (Pvt) Ltd. |
| Fenamic | Unexo Labs (Pvt) Ltd. |
| Fenamic | Unexo Labs (Pvt) Ltd. |
| Fengesic | Werrick Pharmaceuticals |
| Fenstan | Pearl Pharmaceuticals |
| Flamar | Noa Hemis Pharmaceuticals |
| Flamar | Noa Hemis Pharmaceuticals |
| Fonstal | Flow Pharmaceuticals (Pvt) Ltd. |
| Fonstal | Flow Pharmaceuticals (Pvt) Ltd. |
| Fymef | Fynk Pharmaceuticals |
| Fymef | Fynk Pharmaceuticals |
| Gardan | Sanofi Aventis (Pakistan) Ltd. |
| Genston | Genome Pharmaceuticals (Pvt) Ltd |
| Genston | Genome Pharmaceuticals (Pvt) Ltd |
| Genston | Genome Pharmaceuticals (Pvt) Ltd |
| Glomac | Medera Pharmaceuticals (Pvt) Ltd. |
| Hanzel | Lexicon Pharmaceuticals (Pvt) Ltd. |
| Hasmic | Hassan Pharmaceuticals (Pvt) Ltd. |
| Hefmic | Heal Pharmaceuticals Pvt Ltd |
| Ja-Stan | Irza Pharma (Pvt) Ltd. |
| Ja-Stan | Irza Pharma (Pvt) Ltd. |
| Ja-Stan | Irza Pharma (Pvt) Ltd. |
| Kamic | Stanley Pharmaceuticals (Pvt) Ltd. |
| Kaypan | Karachi Chemical Industries |
| Kemistan | Alkemy Pharmaceutical Laboratories (Private) Ltd. |
| Kemistan | Alkemy Pharmaceutical Laboratories (Private) Ltd. |
| Lonstan | Lotus Pharmaceuticals (Pvt) Ltd |
| Mafnol | Ideal Pharmaceutical Industries |
| Mafnol | Ideal Pharmaceutical Industries |
| Mamic | Vega Pharmaceuticals Ltd. |
| Mamic | Vega Pharmaceuticals Ltd. |
| Mamic | Vega Pharmaceuticals Ltd. |
| Martan | Marvi Laboratories |
| Martan | Marvi Laboratories |
| Maximus Tablet | Pakistan Pharmaceutical Products (Pvt) Ltd. |
| Maximus Tablet | Pakistan Pharmaceutical Products (Pvt) Ltd. |
| Maximus Tablet | Pakistan Pharmaceutical Products (Pvt) Ltd. |
| Mb-Stan | Multinational Buisness Link |
| Medocid Plain | Dosaco Laboratories |
| Medocid Plain | Dosaco Laboratories |
| Mefacid | Zafa Pharmaceutical Laboratories (Pvt) Ltd. |
| Mefacid | Zafa Pharmaceutical Laboratories (Pvt) Ltd. |
| Mefad | Paramount Pharmaceuticals |
| Mefad | Paramount Pharmaceuticals |
| Mefad | Paramount Pharmaceuticals |
| Mefadil | P.D.H. Pharmaceuticals (Pvt) Ltd. |
| Mefadil | P.D.H. Pharmaceuticals (Pvt) Ltd. |
| Mefadil | P.D.H. Pharmaceuticals (Pvt) Ltd. |
| Mefadon | Bloom Pharmaceuticals (Pvt) Ltd. |
| Mefaim | Aims Traders |
| Mefaim | Aims Traders |
| Mefalgic | Semos Pharmaceuticals (Pvt) Ltd. |
| Mefalgic | Semos Pharmaceuticals (Pvt) Ltd. |
| Mefcid | Miracle Pharmaceuticals(Pvt) Ltd |
| Mefenamic Acid | Lahore Chemical & Pharmaceutical Works (Pvt) Ltd |
| Mefenamic Acid | Lahore Chemical & Pharmaceutical Works (Pvt) Ltd |
| Mefenamic Acid | Lahore Chemical & Pharmaceutical Works (Pvt) Ltd |
| Mefenamic Acid | Lahore Chemical & Pharmaceutical Works (Pvt) Ltd |
| Mefenamic Acid | Eros Pharmaceuticals |
| Mefenamic Acid | Eros Pharmaceuticals |
| Mefenamic Acid | Geofman Pharmaceuticals |
| Mefenamic Acid | Medicaids Pakistan (Pvt) Ltd. |
| Mefenamic Acid | Munawar Pharma (Pvt) Ltd. |
| Mefenamic Acid | Lahore Chemical & Pharmaceutical Works (Pvt) Ltd |
| Mefenamic Acid | Geofman Pharmaceuticals |
| Mefenamic Acid | Munawar Pharma (Pvt) Ltd. |
| Mefenamic Acid | Ardin Pharmaceuticals |
| Mefenamic Acid | Ardin Pharmaceuticals |
| Mefescot | Scotmann Pharmaceuticals |
| Mefgesic | Wilsons Pharmaceuticals |
| Mefgesic | Wilsons Pharmaceuticals |
| Mefinn | Goodman Laboratories |
| Mefinn | Goodman Laboratories |
| Meflin | Harmann Pharmaceutical Laboratories (Pvt) Ltd. |
| Meflin | Harmann Pharmaceutical Laboratories (Pvt) Ltd. |
| Meflon | Umersons |
| Mefmic | Ferro Pharmaceutical Laboratories |
| Mefmic | Ferro Pharmaceutical Laboratories |
| Mefmic | Ferro Pharmaceutical Laboratories |
| Mefna | Ferroza International Pharmaceuticals (Pvt) Ltd. |
| Mefnac | Efroze Chemical Industries (Pvt) Ltd. |
| Mefnac | Efroze Chemical Industries (Pvt) Ltd. |
| Mefnacin | Hizat Pharmaceutical Industries (Pvt) Ltd. |
| Mefnagen | Genera Pharmaceuticals |
| Mefnagen | Genera Pharmaceuticals |
| Mefnax | Qintar Pharmacuticals |
| Mefo-250 | Tagma Pharma (Pvt) Ltd. |
| Mefomide | Swiss Pharmaceuticals (Pvt) Ltd. |
| Mefomide | Swiss Pharmaceuticals (Pvt) Ltd. |
| Meftac | Alina Combine Pharmaceuticals (Pvt) Ltd. |
| Meftac | Alina Combine Pharmaceuticals (Pvt) Ltd. |
| Meftac | Alina Combine Pharmaceuticals (Pvt) Ltd. |
| Meftan | Euro Pharma International |
| Meftan | Euro Pharma International |
| Meftan | Euro Pharma International |
| Mellin | Harmann Pharmaceutical Laboratories (Pvt) Ltd. |
| Mellin | Harmann Pharmaceutical Laboratories (Pvt) Ltd. |
| Mepon | Ferozsons Laboratoies Ltd. |
| Ministal | Karachi Pharmaceutical Laboratory |
| Ministal | Karachi Pharmaceutical Laboratory |
| Ministal | Karachi Pharmaceutical Laboratory |
| Mofstan | Jinnah Pharmaceuticals |
| Mofstan | Jinnah Pharmaceuticals |
| Mofstan | Jinnah Pharmaceuticals |
| Namic | Valor Pharmaceuticals |
| Nivastan | Polyfine Chempharma (Pvt) Ltd. |
| Obstan | Obsons Pharmaceuticals |
| Panamaz | Hamaz Pharmaceutical (Pvt) Ltd. |
| Panamaz | Hamaz Pharmaceutical (Pvt) Ltd. |
| Panamic | Lisko Pakistan (Pvt) Ltd |
| Panamic | Lisko Pakistan (Pvt) Ltd |
| Pharmic | Pharmacare Laboratories (Pvt) Ltd. |
| Pharmic | Pharmacare Laboratories (Pvt) Ltd. |
| Pharmic | Pharmacare Laboratories (Pvt) Ltd. |
| Phontan | Pharmawise Labs. (Pvt) Ltd. |
| Phontan | Pharmawise Labs. (Pvt) Ltd. |
| Ponfab | Askari Pharmaceuticals. |
| Pongesic | Mass Pharma (Private) Limited |
| Pongesic | Mass Pharma (Private) Limited |
| Pons | Safina Pharma (Pvt) Ltd |
| Ponsac | Brookes Pharmaceutical Laboratories (Pak.) Ltd. |
| Ponsic | Safe Pharmaceutical (Pvt) Ltd. |
| Ponsic | Safe Pharmaceutical (Pvt) Ltd. |
| Ponsic | Safe Pharmaceutical (Pvt) Ltd. |
| Ponstan | Pfizer Laboratories Ltd. |
| Ponstan Flash | Pfizer Laboratories Ltd. |
| Prestan | Shaheen Agencies |
| Protan | Progressive Laboratories |
| Protan | Progressive Laboratories |
| Regocid | Regent Laboratories Ltd. |
| Regocid | Regent Laboratories Ltd. |
| Regocid | Regent Laboratories Ltd. |
| Solacy | Maple Pharmaceuticals (Pvt) Ltd |
| Sonistan | Helicon Pharmaceutek Pakistan (Pvt) Ltd. |
| Sonistan | Helicon Pharmaceutek Pakistan (Pvt) Ltd. |
| Sonistan | Helicon Pharmaceutek Pakistan (Pvt) Ltd. |
| Unistan | Tg Pharma |
| Wenamic | Webros Pharmaceuticals |
| Wilstan | Wilshire Laboratories (Pvt) Ltd. |
| Wilstan | Wilshire Laboratories (Pvt) Ltd. |
| Wilstan | Wilshire Laboratories (Pvt) Ltd. |
| Zegesic | Xenon Pharmaceuticals (Pvt) Ltd. |
| Zopan | Pharmatec Pakistan (Pvt) Ltd. |
Mefenamic Acid Tablets 500 Mg in Pakistan |
|
| A-Pnamic | Pulse Pharmaceuticals |
| Aafia | Maple Pharmaceuticals (Pvt) Ltd |
| Acimef | Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
| Acimef | Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
| Almef Fort | Alson Pharmaceuticals |
| Amic | Libra Pharmaceuticals (Pvt) Ltd |
| Anapan Forte | Star Laboratories (Pvt) Ltd. |
| Anapen Forte | Pharmix Laboratories (Private) Limited. |
| Austan Fort | Ambrosia Pharmaceuticals |
| Deemac Forte | Delux Chemical Industries |
| Deemac Forte | Delux Chemical Industries |
| Delmic | Delta Pharma (Pvt) Ltd. |
| Dologin | Opal Laboratories (Pvt) Ltd. |
| Dolor | Adamjee Pharmaceuticals (Pvt) Ltd. |
| Febrin | Remington Pharmaceutical Industries (Pvt) Ltd. |
| Fenamic Forte | Unexo Labs (Pvt) Ltd. |
| Fenamic Forte | Unexo Labs (Pvt) Ltd. |
| Fenstan Forte | Pearl Pharmaceuticals |
| Flamar Forte | Noa Hemis Pharmaceuticals |
| Fymef | Fynk Pharmaceuticals |
| Gardan Forte | Sanofi Aventis (Pakistan) Ltd. |
| Genston | Genome Pharmaceuticals (Pvt) Ltd |
| Glomac | Medera Pharmaceuticals (Pvt) Ltd. |
| Graymaf Forte | Gray`S Pharmaceuticals |
| Hasmic | Hassan Pharmaceuticals (Pvt) Ltd. |
| Hefmic | Heal Pharmaceuticals Pvt Ltd |
| Inflanil Forte | Global Pharmaceuticals |
| Ja-Stan | Irza Pharma (Pvt) Ltd. |
| Ja-Stan | Irza Pharma (Pvt) Ltd. |
| Ja-Stan | Irza Pharma (Pvt) Ltd. |
| Kamic | Stanley Pharmaceuticals (Pvt) Ltd. |
| Kaypan Forte | Karachi Chemical Industries |
| Lonstan | Lotus Pharmaceuticals (Pvt) Ltd |
| Mamic Forte | Vega Pharmaceuticals Ltd. |
| Maximus Tablet | Pakistan Pharmaceutical Products (Pvt) Ltd. |
| Mb-Stan Forte | Multinational Buisness Link |
| Medgesic | Mediceena Pharma (Pvt) Ltd. |
| Medocid Forte | Dosaco Laboratories |
| Mefadil Forte | P.D.H. Pharmaceuticals (Pvt) Ltd. |
| Mefalgic Forte | Semos Pharmaceuticals (Pvt) Ltd. |
| Mefco Forte | Eros Pharmaceuticals |
| Mefco Forte | Eros Pharmaceuticals |
| Mefco Forte | Eros Pharmaceuticals |
| Mefgesic | Wilsons Pharmaceuticals |
| Mefheim | Pakheim Internanational Pharma |
| Mefnac | Efroze Chemical Industries (Pvt) Ltd. |
| Mefnax | Qintar Pharmacuticals |
| Mefo | Tagma Pharma (Pvt) Ltd. |
| Mefomide | Swiss Pharmaceuticals (Pvt) Ltd. |
| Meftac | Alina Combine Pharmaceuticals (Pvt) Ltd. |
| Mofstan | Jinnah Pharmaceuticals |
| Namic Forte | Valor Pharmaceuticals |
| Nengesic | Nenza Pharmaceuticals (Pvt) Limited |
| Neomef | Neo Medix |
| Novomic | Krka-Pak Pharmaceutical & Chemical Works |
| Painton Forte | Alliance Pharmaceuticals (Pvt) Ltd. |
| Panamaz Forte | Hamaz Pharmaceutical (Pvt) Ltd. |
| Panamaz Forte | Hamaz Pharmaceutical (Pvt) Ltd. |
| Pharmic Forte | Pharmacare Laboratories (Pvt) Ltd. |
| Ponfab | Askari Pharmaceuticals. |
| Pongesic | Mass Pharma (Private) Limited |
| Ponsac Forte | Brookes Pharmaceutical Laboratories (Pak.) Ltd. |
| Ponstan Forte | Pfizer Laboratories Ltd. |
| Ponstan Forte | Pfizer Laboratories Ltd. |
| Regocid Forte | Regent Laboratories Ltd. |
| Remostan | Syntex Pharmaceuticals |
| Remostan | Syntex Pharmaceuticals |
| Remostan | Syntex Pharmaceuticals |
| Sapimic | Sapient Pharma |
| Solacy | Maple Pharmaceuticals (Pvt) Ltd |
| Vio-Mef Forte | Venus Pharma |
| Vio-Mef Forte | Venus Pharma |
| Vio-Mef Forte | Venus Pharma |
| Wenamic | Webros Pharmaceuticals |
| Wilstan Forte | Wilshire Laboratories (Pvt) Ltd. |
| Zopan | Pharmatec Pakistan (Pvt) Ltd. |
