Leseany asked
I am pharmacist. i gave mefenamic 500mg tid after meals to patient suffer from menstrual pain. she was suspected with ulcer but in my country celecoxib is not registered. i gave hermefenamic instead of ibuprofen that increase bleeding or dicofenac which is most irritant to git than others,so is this very dangerous situation? does sever complication will happen immediately (notice that i told her that drug may increase git irritation and i guess she will use it not more than two days maximum)?
Answer
Treatment for dysmenorrhea are unfortunately lacking many effective therapies. NSAIDs are by far the most common treatment and are in fact, one of the only treatments used.
NSAID use with an active GI disease (such as peptic ulcers) is certainly a precaution but NOT a contraindication. NSAIDs that are more COX-2 selective are recommended due to the fact that they will not inhibit protective prostaglandin formation by the epithelial cells in the stomach.
We have included a chart for your regarding COX-2 selectivity. We can see that Mefenamic acid is pretty much right in the middle of all the NSAIDs regarding COX-2 selectivity (the chart only lists meclofenamate, but they are in the same chemical class and therefore very similar). It certainly is not as harmful as say ketorolac which has listed in its package insert to not use for more than 5 days.
Since your patient will only be on the medication 1-2 days, I would think that this is not a serious situation. The blocking of prostaglandin formation usually takes its toll over time, so 1-2 days shouldn't be very harmful. The patient should be aware to look for signs and symptoms of a worsening ulcer such as abdominal pain and blood in the stool. As with any therapy, you are really just weighing the risks vs. benefits, so as long as the patient is aware of the risks, there shouldn't be much of a problem.
