- Dosages
- Side effects in children
- Warnings & precautions in children
- Contra-indications in children
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Interactions - PK
- Renal impairment
- References
Pharmacokinetics in children
No information is present at this moment.
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dose recommendation of formulary compared to licensed use (on-label versus off-label)
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Available formulations
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Dosages
| Acute and chronic pain (including rheumatic diseases), fever, pain, swelling and inflammation after injury or surgery |
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Renal impaiment in children > 3 months
Adjustment in renal impairment as specified:
GFR 50-80 ml/min/1.73 m2
Consider whether the use of NSAIDs is justified. If mefenamic acid is still prescribed and the patient belongs to a risk group: Check kidney function before and within 1 week after starting treatment with mefenamic acid.GFR 30-50 ml/min/1.73 m2
Consider whether the use of NSAIDs is justified. If mefenamic acid is still prescribed and the patient belongs to a risk group: Check kidney function before and within 1 week after starting treatment with mefenamic acid.GFR 10-30 ml/min/1.73 m2
Consider whether the use of NSAIDs is justified. If mefenamic acid is still prescribed and the patient belongs to a risk group: Check kidney function before and within 1 week after starting treatment with mefenamic acid.GFR < 10 ml/min/1.73 m2
General information cannot be given.Clinical consequences
Risk factors include heart failure, cirrhosis of the liver, nephrotic syndrome, chronic kidney disease, factors that promote dehydration (e.g. heat), taking kidney-damaging medications such as diuretics or RAAS inhibitors.
NSAIDs (including COX-2 inhibitors) can cause acute renal failure due to decreased kidney perfusion (due to hypovolaemia). Usually, excessive decrease in kidney perfusion is prevented by increased prostaglandin synthesis in the kidneys. NSAIDs interfere with this compensation mechanism. Reduced kidney perfusion also leads to water and salt retention, which leads to the development or worsening of high blood pressure and heart failure.
Patients on dialysis
Hemodialysis / continuous veno-venous hemodialysis / hemofiltration:
• Kidney function (urine production) present: Do not use to maintain residual kidney function.
• Renal function (urine production) NOT present: Avoidance of use is not necessary.
Patients on dialysis are at higher risk of bleeding, which is likely due to abnormal platelet function. The risk of bleeding can be increased by using a low molecular weight heparin to avoid coagulation in the extracorporeal circulation at the beginning of hemodialysis.
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The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here
Side effects in children
Hypothermia has occurred in children and adolescents with an unknown frequency.
Kidney failure, posterior reversible leukoencephalopathy and pancreatitis have occurred in children. [(Wurm, Schreiber et al. 2015), (Yokobori, Yokota et al. 2006), (Itami, Akutsu et al. 1990), (Onay, Ercoban et al. 2009)].
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The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here
Contra-indications
No information available on specific contra indications in children.
The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here
Warnings & precautions in children
An overdose of mefenamic acid in children can lead to seizures. (Robson, Balali et al. 1979) (Kamour, Crichton et al. 2017)
In children, mefenamic acid should not be given for longer than 7 days unless it is used to treat Still's disease. (Pfizer 03/2019)
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Interactions
The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here
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| Acetic acid derivatives and related substances | ||
|---|---|---|
| M01AB05 | ||
| M01AB01 | ||
| Oxicams | ||
|---|---|---|
| M01AC01 | ||
| Propionic acid derivatives | ||
|---|---|---|
| M01AE14 | ||
| M01AE01 | ||
| M01AE02 | ||
| Coxibs | ||
|---|---|---|
| M01AH01 | ||
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References
- Onay, OS,, Acute, reversible nonoliguric renal failure in two children associated with analgesic-antipyretic drugs, Pediatr Emerg Care, 2009, 25(4), 263-266
- Pfizer, SmPC Parkemed 250 mg Kps. (12949), 03/2019
- Robson, RH,, Mefenamic acid poisoning and epilepsy, Br Med J, 1979, 2(6202), 1438
- Pfizer, SmPC Parkemed orale Suspension (13621), 03/2019
- Itami, N,, Progressive renal failure despite discontinuation of mefenamic acid, Nephron, 1990, 54(3), 281-282
- Kamour, A,, Central nervous system toxicity of mefenamic acid overdose compared with other NSAIDs: an analysis of cases reported to the United Kingdom National Poisons Information Service, Br J Clin Pharmacol, 2017, 83(4), 855-862
- Yokobori, S,, Pediatric posterior reversible leukoencephalopathy syndrome and NSAID-induced acute tubular interstitial nephritis, Pediatr Nephrol, 2006, 34(3), 245-247
- Pfizer, SmPC Parkemed 125 mg Supp. (14290), 03/2019
- Pfizer, SmPC Parkemed 500 mg Supp. (14291), 03/2019
- Wurm, S,, Mefenamic acid: A possible cause of drug-induced acute pancreatitis, Pancreatol, 2015, 15(5), 570-572
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Changes
Changes
