Acemetacin (Emflex) - Uses, Dose, MOA, Brands, Side effects

A non-steroidal anti-inflammatory medicine called acemetacin (Emflex) is used to treat pain and inflammation caused by rheumatic conditions like osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

Additionally, it is used to alleviate lower back discomfort and pain following surgery.

It results in less stomach damage than indomethacin. The low impact on leukotriene B4 synthesis and tumour necrosis factor (TNF) expression, which results in reduced stimulation of leukocyte-endothelial adhesion, may be the reason of this effect.

Acemetacin Vs Ibuprofen:

Compared to ibuprofen, Emflex has a longer half-life. It is thus used once or twice daily, while ibuprofen is administered 6 hourly for round-the-clock pain relief.

The efficacy and safety have not been compared in clinical trials, however, the gastrointestinal side effects of acemetacin seem lower than that of ibuprofen.

Emflex is not approved by the FDA and EMA while Ibuprofen is a time-tested drug approved in many countries.

Ibuprofen is available as OTC (over the counter) medicine for mild to moderate pain, however, acemetacin is a prescription medicine. 

Acemetacin Contraindications

Active gastrointestinal bleeding, gastric ulceration, gastrointestinal bleeding or gastrointestinal perforation caused by a previous NSAID therapy

Recurrent gastrointestinal hemorhage (or ulceration) that has occurred in two or three episodes. Severe heart failure.


Hypersensitivity to NSAIDs should be notified.

Cerebrovascular, cardiac and other diseases.

Bleeding disorders and coagulation problems can cause prolonged bleeding.

NSAIDs can exacerbate Crohn's disease.

In cases of epilepsy, heart failure, ischemic heart disease, parkinsonism, peripheral arterial disease, and mental health issues, use with caution.

Monitoring parameters

Eye examination and blood examination is advisable in patients using Acemetacin for a longer time.

Acemetacin 60 mg, 90 mg, and 180 mg dose:

  • oral capsules 60 mg twice daily.
  • The sustained release formulation ( 90 mg SR) may be taken once daily.

Acemetacin maximum dose:

The maximum dose of acemetacin is 180 mg/day. It should be administered in two or three divided doses. 

Dose in Children:

Not recommended for use in children. 

Dose in Kidney Disease:

Avoid if possible in renal failure. If used, the lowest effective dose may be used for the shortest possible time.

It may cause sodium and water retention and lead to worsening of renal function.

Dose in Liver Disease:

Gastrointestinal bleeding and fluid retention can occur. Avoid in severe liver disease. 

How to administer?

Like most NSAIDs, it should be taken with meals to avoid gastrointestinal side effects.

Pregnancy Category C (1st and 2nd Trimester)

Pregnancy Category D (3rd trimester)

If there are no benefits, NSAIDs should not be used during pregnancy.

Avoid it in the third trimester. It can cause premature closure of ductus arteriosus and persistent pulmonary hypertension.

NSAIDs may also prolong labor and delay it.

Use during lactation:

Do not breastfeed NSAIDs, or use them with caution.

Acemetacin Side Effect:

Like all NSAIDs, Acemetacin can cause gastritis, gastrointestinal ulceration, gastrointestinal bleeding, and heartburn.

Acemetacin also causes salt and fluid retention. It may exacerbate heart and renal failure.

Rare side effects:

  • Alveolitis,
  • aseptic meningitis (patients with connective tissue disorders such as systemic lupus erythematosus may be especially susceptible),
  • hepatic damage,
  • interstitial fibrosis associated with NSAIDs can lead to renal failure,
  • pancreatitis,
  • papillary necrosis associated with NSAIDs can lead to renal failure,
  • pulmonary eosinophilia,
  • Stevens-Johnson syndrome,
  • toxic epidermal necrolysis, and
  • visual disturbances.

Side effects with frequency not known:

  • Angioedema,
  • blood disorders,
  • bronchospasm,
  • colitis
  • Crohn’s disease
  • depression,
  • diarrhea,
  • dizziness,
  • drowsiness,
  • fluid retention
  • gastrointestinal bleeding,
  • gastrointestinal discomfort,
  • gastrointestinal disturbances,
  • gastrointestinal ulceration,
  • haematuria,
  • headache,
  • hearing disturbances,
  • hypersensitivity reactions,
  • insomnia,
  • nausea,
  • nervousness,
  • photosensitivity,
  • raised blood pressure,
  • rashes,
  • renal failure
  • tinnitus, and
  • vertigo.

In addition, long-term treatment is associated with reduced female fertility. 

MOA (Mechanism of action) of Acemetacin:

Acemetacin blocks the action of cyclooxygenase, which is involved in the production prostaglandins.

It can be used to treat painful and inflammatory conditions like arthritis. 

Brands in Pakistan:

No brands are available in Pakistan.

International Brands of Acemetacin:

  • Acemetacin Heumann
  • Acemetacin intermuti
  • Acemetacin Stada
  • acemetacin von ct
  • Acemix
  • Acephlogont
  • Altren
  • Analgel
  • Azeat
  • Emflex
  • Espledol
  • Flamarion
  • Gynalgia
  • Mostanol
  • Oldan
  • Rantudil
  • Rheutrop
  • Solart
  • Tilur

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