General

Pronunciation:
me-kloe-fen-am-ate

Trade Name(s)

• Meclomen

Ther. Class.

antirheumatics

nonopioid analgesics

Pharm. Class.

nonsteroidal anti inflammatory drugs nsaids

Indications

• Management of mild to moderate pain, including:

  • Rheumatoid arthritis,
  • Osteoarthritis,
  • Dysmenorrhea.
• Management of excessive menstrual flow.

Action

Inhibits prostaglandin synthesis.

Therapeutic Effect(s):

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

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;
• Cross-sensitivity may occur with other NSAIDs, including aspirin;
• Active GI bleeding or ulcer disease;
• OB:  Avoid use after 30 wk gestation;
• Lactation:  Lactation.

Use Cautiously in:

• Severe cardiovascular, renal, or hepatic disease;
• History of ulcer disease;
• OB:  Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible;
• Pedi:   Children <14 yr (safety and effectiveness not established);
• Geri:  Older adults are at ↑ risk for side effects.

Adverse Reactions/Side Effects

CV: edema

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), hives, itching, STEVENS-JOHNSON SYNDROME

EENT: tinnitus, visual disturbances

GI: diarrhea, dyspepsia, nausea, vomiting, anorexia, constipation, discomfort, flatulence, GI BLEEDING, HEPATITIS, stomatitis

GU: renal failure

Hemat: blood dyscrasias

Neuro: dizziness, headache, drowsiness

Misc: HYPERSENSITIVITY REACTIONS (including anaphylaxis), drug-induced systemic lupus erythematosus–like syndrome

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Concurrent use with  aspirin  may ↓ levels and effectiveness.
• May ↑ risk of bleeding with  thrombolytic agents,  cefotetan,  valproic acid,  clopidogrel,  eptifibatide, and tirofiban.
• Additive adverse GI side effects with  aspirin,  alcohol,  corticosteroids,  potassium supplements, and other  NSAIDs.
•  Probenecid  ↑ levels and risk of 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.

Drug-Natural Products:

↑ bleeding risk with  anise,  arnica,  chamomile,  clove,  feverfew,  garlic,  ginger,  ginkgo,  Panax ginseng , and others.

Route/Dosage

PO (Adults): Anti-inflammatory: 200–400 mg/day in 3–4 divided doses.  Analgesic: 50–100 mg every 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

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.
• Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. Discontinue therapy if symptoms occur.
• 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.

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.
• PO 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.
• Rep:  May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid meclofenamate in the 3rd trimester of pregnancy (after 29 wk), may cause premature closure of the fetal ductus arteriosus. Use of meclofenamate after 20 wk may cause fetal renal dysfunction leading to oligohydramnios. May cause reversible infertility in women attempting to conceive; may consider discontinuing meclofenamate.

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.