lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Capsule
CAUTIONARY AND ADVISORY LABELS 21
▶Indometacin (Non-proprietary)
Indometacin 25 mgIndometacin 25 mg capsules| 28 capsuleP
£ 5. 00 DT = £ 0. 83
Indometacin 50 mgIndometacin 50 mg capsules| 28 capsuleP
£ 7. 50 DT = £ 1. 24Mefenamic acid 05-Oct-2016
lINDICATIONS AND DOSE
Acute pain including dysmenorrhoea|Menorrhagia
▶BY MOUTH
▶Child 12–17 years: 500 mg 3 times a daylCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.history of gastro-
intestinal bleeding related to previous NSAID therapy.
history of gastro-intestinal perforation related to previous
NSAID therapy.history of recurrent gastro-intestinal
haemorrhage (two or more distinct episodes).history of
recurrent gastro-intestinal ulceration (two or more
distinct episodes).inflammatory bowel disease.severe
heart failure
lCAUTIONSAcute porphyrias p. 603 .allergic disorders.
cardiac impairment (NSAIDs may impair renal function).
cerebrovascular disease.coagulation defects.connective-
tissue disorders.Crohn’s disease (may be exacerbated).
epilepsy.heart failure.ischaemic heart disease.
peripheral arterial disease.risk factors for cardiovascular
events.ulcerative colitis (may be exacerbated).
uncontrolled hypertension
lINTERACTIONS→Appendix 1 : NSAIDs
lSIDE-EFFECTSAgranulocytosis.anaemia.angioedema.
appetite decreased.asthma.bone marrow disorders.
confusion.constipation.Crohn’s disease.depression.
diarrhoea (discontinue).disseminated intravascular
coagulation.dizziness.drowsiness.dyspnoea.dysuria.
ear pain.eosinophilia.eye irritation.fatigue.fertility
decreased female.gastrointestinal discomfort.
gastrointestinal disorders.glomerulonephritis.glucose
tolerance impaired.haemolytic anaemia.haemorrhage.
hallucination.headache.heart failure.hepatic disorders.
hyperhidrosis.hypersensitivity.hypertension.
hyponatraemia.hypotension.insomnia.leucopenia.
malaise.meningitis aseptic (patients with connective-
tissue disorders such as systemic lupus erythematosus may
be especially susceptible).multi organ failure.nausea.
nephritis acute interstitial.nephrotic syndrome.
nervousness.neutropenia.oedema.optic neuritis.oral
ulceration.palpitations.pancreatitis.paraesthesia.
photosensitivity reaction.proteinuria.rash (discontinue).
renal failure (more common in patients with pre-existing
renal impairment).renal failure non-oliguric.renal
papillary necrosis.respiratory disorders.seizure.sepsis.
severe cutaneous adverse reactions (SCARs).skin
reactions.thrombocytopenia.tinnitus.vertigo.vision
disorders.vomiting
SIDE-EFFECTS, FURTHER INFORMATIONFor information
about cardiovascular and gastrointestinal side-effects, and
a possible exacerbation of symptoms in asthma, see Non-
steroidal anti-inflammatory drugs p. 650.
OverdoseMefenamic acid has important consequences in
overdosage because it can cause convulsions, which if
prolonged or recurrent, require treatment.For details on the management of poisoning, see
Emergency treatment of poisoning , in particular,
Convulsions p. 832.
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with a history of hypersensitivity to aspirin or any
other NSAID—which includes those in whom attacks of
asthma, angioedema, urticaria or rhinitis have been
precipitated by aspirin or any other NSAID.
lPREGNANCYAvoid unless the potential benefit outweighs
the risk. Avoid during the third trimester (risk of closure of
fetal ductus arteriosusin uteroand possibly persistent
pulmonary hypertension of the newborn); onset of labour
may be delayed and duration may be increased.
lBREAST FEEDINGUse with caution during breast-feeding.
Amount too small to be harmful but manufacturer advises
avoid.
lHEPATIC IMPAIRMENTUse with caution; there is an
increased risk of gastro-intestinal bleeding andfluid
retention. Avoid in severe liver disease.
lRENAL IMPAIRMENTAvoid if possible or use with caution.
Avoid in severe impairment.
Dose adjustmentsThe lowest effective dose should be used
for the shortest possible duration.
MonitoringIn renal impairment monitor renal function;
sodium and water retention may occur and renal function
may deteriorate, possibly leading to renal failure.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Oral suspension
CAUTIONARY AND ADVISORY LABELS 21
EXCIPIENTS:May contain Ethanol
▶Mefenamic acid (Non-proprietary)
Mefenamic acid 10 mg per 1 mlMefenamic acid 50 mg/ 5 ml oral
suspension| 125 mlP£ 179. 00 DT = £ 179. 00
Tablet
CAUTIONARY AND ADVISORY LABELS 21
▶Mefenamic acid (Non-proprietary)
Mefenamic acid 500 mgMefenamic acid 500 mg tablets|
28 tabletP£ 60. 00 DT = £ 42. 50 | 84 tabletP£ 108. 00 –
£ 170. 00
▶Ponstan(Chemidex Pharma Ltd)
Mefenamic acid 500 mgPonstan Forte 500 mg tablets|
100 tabletP£ 15. 72
Capsule
CAUTIONARY AND ADVISORY LABELS 21
▶Mefenamic acid (Non-proprietary)
Mefenamic acid 250 mgMefenamic acid 250 mg capsules|
100 capsuleP£ 60. 10 DT = £ 18. 66
▶Ponstan(Chemidex Pharma Ltd)
Mefenamic acid 250 mgPonstan 250 mg capsules|
100 capsuleP£ 8. 17 DT = £ 18. 66Meloxicam
lINDICATIONS AND DOSE
Exacerbation of osteoarthritis (short-term)
▶BY MOUTH
▶Child 16–17 years: 7. 5 mg once daily, then increased if
necessary up to 15 mg once daily
Pain and inflammation in rheumatic disease|Ankylosing
spondylitis
▶BY MOUTH
▶Child 16–17 years: 15 mg once daily, then reduced to
7. 5 mg once daily if required658 Pain and inflammation in musculoskeletal disorders BNFC 2018 – 2019
Musculoskeletal system10