Meclomen


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meclofenamate

(me-kloe-fen-am-ate) ,

Meclomen

(trade name)

Classification

Therapeutic: antirheumatics
Pharmacologic: fenamate
Pregnancy Category: UK

Indications

Management of mild to moderate pain, including:
  • Rheumatoid arthritis,
  • Osteoarthritis,
  • Dysmenorrhea.
Management of excessive menstrual flow.

Action

Inhibits prostaglandin synthesis.

Therapeutic effects

Suppression of pain and inflammation.

Pharmacokinetics

Absorption: Well absorbed from the GI tract.
Distribution: Unknown.
Protein Binding: >99%.
Metabolism and Excretion: Metabolized by the liver; some active metabolites.
Half-life: 40 min–2 hr.

Time/action profile

ROUTEONSETPEAKDURATION
PO (analgesic)within 1 hrunknown4–6 hr
PO (anti-inflammatory)days2–3 wkdays

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity may occur with other NSAIDs, including aspirin; Active GI bleeding or ulcer disease.
Use Cautiously in: Severe cardiovascular, renal, or hepatic disease; History of ulcer disease; Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <14 yr (safety not established; avoid use during 2nd half of pregnancy).

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • headache (most frequent)
  • drowsiness

Ear, Eye, Nose, Throat

  • tinnitus
  • visual disturbances

Cardiovascular

  • edema

Gastrointestinal

  • GI bleeding (life-threatening)
  • drug-induced hepatitis (life-threatening)
  • diarrhea (most frequent)
  • dyspepsia (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • anorexia
  • constipation
  • discomfort
  • flatulence
  • stomatitis

Genitourinary

  • renal failure

Dermatologic

  • hives
  • itching

Hematologic

  • blood dyscrasias

Miscellaneous

  • allergic reactions including anaphylaxis and Stevens-Johnson syndrome (life-threatening)
  • drug-induced systemic lupus erythematosus–like syndrome

Interactions

Drug-Drug interaction

Concurrent use with aspirin may ↓ meclofenamate blood levels and may ↓ effectiveness.May ↑ risk of bleeding with thrombolytic agents, cefoperazone, cefotetan, valproic acid, clopidogrel, ticlopidine, eptifibatide, andtirofiban.Additive adverse GI side effects with aspirin, alcohol, corticosteroids, potassium supplements, and other NSAIDs.Probenecid ↑ blood levels and may ↑ toxicity.Chronic use with acetaminophen or gold compounds may ↑ the risk of adverse renal reactions.May decrease the effectiveness of antihypertensives or diuretics.May ↑ risk of hypoglycemia from oral hypoglycemic agents or insulins.↑ risk of hematologic adverse reactions with antineoplastics or radiation therapy.May ↑ levels and toxicity from lithium or methotrexate.↑ risk of nephrotoxicity with cyclosporine.↑ bleeding risk with anise, arnica, chamomile, clove, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.

Route/Dosage

Oral (Adults) Anti-inflammatory—200–400 mg/day in 3–4 divided doses. Analgesic—50–100 mg q 4–6 hr (not to exceed 400 mg/day). Dysmenorrhea/excessive menstrual flow—100 mg 3 times daily for up to 6 days or until cessation of menses.

Availability (generic available)

Capsules: 50 mg, 100 mg

Nursing implications

Nursing assessment

  • Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Monitor for rhinitis, asthma, and urticaria.
  • Assess patient for skin rash frequently during therapy. Discontinue meclofenamate at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.
  • Arthritis: Assess pain and range of movement before and periodically during therapy.
  • Pain: Assess location, duration, and intensity of pain before and 1 hr after administration.
  • Lab Test Considerations: Evaluate BUN, serum creatinine, CBC, and liver function tests periodically in patients receiving prolonged therapy.
    • May ↑serum potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST, and ALT levels. May ↓ hemoglobin and hematocrit concentrations, leukocyte and platelet counts, and CCr.
    • Effects on bleeding time are minimal.

Potential Nursing Diagnoses

Acute pain (Indications)
Impaired physical mobility (Indications)

Implementation

  • Administration in higher than recommended doses does not provide increased effectiveness but may cause increased side effects.
    • Coadministration with opioid analgesics may have additive analgesic effects and may permit lower opioid doses.
  • Oral: For rapid initial effect, administer 30 min before or 2 hr after meals. May be administered with food, milk, or antacids to decrease GI irritation.
  • Dysmenorrhea: Administer as soon as possible after the onset of menses. Prophylactic treatment has not been shown to be effective.

Patient/Family Teaching

  • Advise patients to take this medication with a full glass of water and to remain in an upright position for 15–30 min after administration.
  • Instruct patient to take medication exactly as directed. If a dose is missed, take as soon as remembered but not if almost time for next dose. Do not double doses.
  • May occasionally cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
  • Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, or other OTC medications without consulting health care professional.
  • Advise patient to inform health care professional of medication regimen before treatment or surgery.
  • Caution patient to wear sunscreen and protective clothing to prevent photosensitivity reactions.
  • Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Decreased severity of pain.
  • Improved joint mobility. Partial arthritic relief is usually seen within a few days, but maximum effectiveness may require 2–3 wk of continuous therapy. Patients who do not respond to one NSAID may respond to another.
  • Decreased menstrual flow.

meclofenamate

An anthranilic-type NSAID, which is tightly bound to albumin, used for arthritic complaints, dysmenorrhoea and vascular headache.
 
T1/2
3–4 hours.

Excretion
Renal, gastrointestinal.
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