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Lithium toxicity and mefenamic acid. A possible interaction and the role of prostaglandin inhibition.

An elderly patient with bipolar manic-depressive psychosis, stabilised satisfactorily on lithium carbonate, developed acute symptoms of lithium toxicity shortly after commencing mefenamic acid. Vulnerability factors for the interaction may have included age, history of cardiac failure, and impaired glomerular function. It is hypothesised that the interaction may have been mediated by inhibition of prostaglandin activity.

Bipolar Disorder↗

Single-blind study of diflunisal versus mefenamic acid in the treatment of pain after Colles' fracture.

A single-blind study was carried out in 52 patients with severe pain after Colles' fracture to assess the analgesic efficacy and tolerability of 500 mg diflunisal twice daily compared with that of 500 mg mefenamic acid given 3-times daily over a period of 5 days. The results showed that both treatments were effective in relieving pain, night pain and limitation of movement by pain, and there was no significant difference between the response in the two groups. Both drugs were tolerated and only 3 patients (2 on diflunisal) reported mild drug-related side-effects.

Adult↗

Synthesis of 1-beta-O-acyl glucuronides of diclofenac, mefenamic acid and (S)-naproxen by the chemo-selective enzymatic removal of protecting groups from the corresponding methyl acetyl derivatives.

Using a straightforward chemo-enzymatic procedure, 1-beta-O-acyl glucuronides of three non-steroidal anti-inflammatory drugs, diclofenac (DF) 5, mefenamic acid (MF) 6 and (S)-naproxen (NP) 7, were prepared. Caesium salts of these carboxylic acid drugs reacted with commercially available methyl 2,3,4-tri-O-acetyl-1-bromo-1-deoxy-alpha-D-glucopyranuronate 4 to give exclusively the corresponding 1-beta-O-acyl glucuronides 8-10 in moderate yields. The protecting acetyl (for -OH group) and methyl ester (for -CO2H group) groups of each sugar moiety were easily removed to provide the corresponding free 1-beta-O-acyl glucuronides 1-3 in high yields. Deprotection was achieved through effective enzyme-catalysed chemo-selective hydrolyses of the acetyl groups using lipase AS Amano (LAS), and of the methyl ester group using esterase from porcine liver (PLE).

Acylation↗

[Mefenamic acid (Ponstan)-induced acute interstitial nephritis with reversible, severe, non-oliguric renal failure].

Acute interstitial nephritis is a rare complication of treatment with non-steroidal antiinflammatory drugs. A case is reported with severe, reversible, non-oliguric renal failure caused by biopsy-proven acute interstitial nephritis after therapy with mefenamic acid (Ponstan). Prednisone treatment resulted in normalization of renal function within 4 weeks.

Acute Kidney Injury↗

[The effect of mefenamic acid on the immunity indices and hemostatic system in cancer patients and on the cathepsin D-like protease activity in the tissues in cancer of the large intestine].

The study of the effect of sodium mefenaminate on radiation resistance of rats yielded positive results. Clinical investigations showed mefenamic acid to decrease the activity of cathepsin D-like protease in colonic cancer tissue. The acid failed to affect the proteolytic activity of the normal mucosa. It revealed an immunomodulating activity and influenced the hemostatic system which usually manifested itself in amelioration of hypercoagulation.

Adjuvants, Immunologic↗

[Inhibition of thrombocyte function by non-steroidal anti-rheumatic agents: a comparative study between diclofenac, acemetacin, mefenamic acid and ibuprofen].

Non-steroidal antiinflammatory drugs (NSAID) interfere with the synthesis of prostaglandins by inhibiting cyclooxygenase. In blood platelets, this leads to a lack of thromboxane synthesis comparable to the congenital defect which is known to be associated with enhanced bleeding tendency, although the bleeding time may not be prolonged. The four NSAID diclofenac, acemetacin, ibuprofen, and mefenamic acid administered to healthy volunteers at the recommended dosage led to significant suppression of thromboxane synthesis; this effect was more pronounced with acemetacin and ibuprofen than with diclofenac. After intake of NSAID enhanced bleeding during surgery must be expected; in individuals with additional impairment of the hemostatic system (i.e. treatment with oral anticoagulants, mild haemophilia, von Willebrand's disease, mild thrombocytopenia), spontaneous bleeding may occur.

Anti-Inflammatory Agents, Non-Steroidal↗

Randomised placebo controlled trial of mefenamic acid for premedication at outpatient hysteroscopy: a pilot study.

An increasing number of diagnostic hysteroscopies are being performed in an outpatient setting. Most women tolerate the examination well, but the single commonest reason for failure is pain. We assessed the efficacy of a nonsteroidal, anti-inflammatory analgesic as premedication before hysteroscopy in a double-blind, placebo controlled trial. Our results showed that 500 mg mefenamic acid given one hour before hysteroscopy had no significant benefit in the discomfort experienced during the procedure but did significantly reduce pain after hysteroscopy. A larger dose or a longer interval between premedication and hysteroscopy may possibly be associated with greater benefits.

Adult↗

Postoperative management of pain by the use of ponstel (mefenamic acid), a nonsteroidal anti-inflammatory agent.

Early, painfree ambulation is one of the primary goals for postoperative foot patients. Often patients remain in bed, not because of pain but because of side effects of narcotic analgesic agents. Ambulation can be dangerous, but if it is delayed, the prolonged bed rest can lead to circulatory complications. For this reason, and to minimize the use of addictive narcotics, the author has used a non-narcotic, anti-inflammatory agent called Ponstel (mefenamic acid) as the mainstay in postoperative management of pain. Ponstel has been in constant use for 12 years for hospital and office surgical procedures. A review of 192 cases performed over a 4-year period in Westbury General Hospital, Houston, Texas, suggests that this agent is safe, well tolerated, and minimizes the need for narcotic analgesic agents during the early postoperative period.

Adolescent↗

[Use of mefenamic acid as a connective tissue stabilizer in treating arthropathic psoriasis].

The findings of biochemical studies, carried out in 30 patients suffering from psoriatic arthropathy, are analyzed. The parameters examined are: the blood and urine glycosaminoglycans, urine hydroxyproline levels, and blood hyaluronate glycan hydrolase and N-acetyl-B-D-glucosaminidase activities, i. e. the matrix and collagen metabolites as the indicators of the connective tissue destruction and lysosomal enzymes activation responsible, among other factors, for this destruction. The studies have revealed a correlation between the enzymic activity augmentation and the levels of the connective tissue degradation products and the dissemination and severity of the skin and articular processes. The patients have been treated with mefenamic acid, an enzymic activity inhibitor. The therapy has been effective in 76% of patients; 13% of these have developed a remission shortly after therapy (in 46.7 days on an average). The therapy has alleviated both skin and articular symptoms; a tendency to normalization of the biochemical characteristics has been observed. A continuous course of therapy has not been associated with side effects. The author recommends this pathogenetically based and confirmed by laboratory investigations method to be included into a complex of therapeutic measures for patients with psoriatic arthropathy.

Adolescent↗