Meclofenamate

MECLOMEN

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What it isFenamate NSAID; arthritis, pain and dysmenorrhea.

Why this oneEffective for dysmenorrhea and menorrhagia, as the fenamates generally are.

What limits itDiarrhea is notably frequent among the fenamates. Standard NSAID GI, renal and cardiovascular risk; it raises serum lithium.

FDA-approved for

Rheumatoid arthritis (1980)
osteoarthritis (1980)
mild-to-moderate pain (1980)
dysmenorrhea (1980)

FDA label

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BOXED WARNING NSAID class: increased risk of serious cardiovascular thrombotic events (MI, stroke; may increase with duration) and serious GI bleeding, ulceration, and perforation (can occur without warning; elderly at greater risk); contraindicated in CABG surgery setting

FDA dosing	Population	Start	Target	Max
Mild to moderate pain	adults	50 mg q4–6h	50–100 mg q4–6h (100 mg if needed for optimal relief)	400 mg/day
Excessive menstrual blood loss & primary dysmenorrhea	adults	100 mg TID, starting at onset of menstrual flow	100 mg TID up to 6 days	400 mg/day
Rheumatoid arthritis & osteoarthritis (incl. acute exacerbations)	adults	200 mg/day in 3–4 divided doses (initiate at lower dosage)	200–400 mg/day in 3–4 divided doses, individualized	400 mg/day

Renal Undefined

Hepatic Undefined

Instructions

Use lowest effective dose for shortest duration consistent with treatment goals
May take with meals or milk if GI complaints occur
RA/OA: 2–3 wk may be needed for optimum benefit; a lower dose may suffice long-term
Terminate therapy if any severe adverse reaction occurs

Contraindications

Asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs (severe, rarely fatal anaphylactic-like reactions reported)
Setting of coronary artery bypass graft (CABG) surgery

Cautions

Serious CV thrombotic events (MI, stroke) — risk may occur early and increase with duration of use
Serious GI bleeding, ulceration, perforation — any time, without warning symptoms; elderly at greater risk
Fetal toxicity: avoid at ≥30 wk gestation; limit use at 20–30 wk (see pregnancy)

Adverse reactions

Diarrhea (10–33%, dose-related; ~4% discontinued)
Nausea/vomiting (11%)
Other GI disorders (10%)
Abdominal pain, pyrosis, flatulence (3–9%)
Rash, headache, dizziness (3–9%)
Edema, urticaria, pruritus, tinnitus
<1%: GI bleeding/perforation, peptic ulcer, renal failure, blood dyscrasias (neutropenia, agranulocytosis, hemolytic anemia), SJS/TEN/erythema multiforme, hepatic test alterations

Pregnancy Avoid at ≥30 wk gestation (premature closure of fetal ductus arteriosus); limit dose/duration at 20–30 wk (oligohydramnios/fetal renal dysfunction); consider ultrasound monitoring if use >48 h at ≥20 wk

Lactation Undefined

⚠ BOXED WARNINGS