Meclomen

meclofenamate

(me-kloe-fen-am-ate) ,

Meclomen

(trade name) Pregnancy Category: UK

Indications

Action

Pharmacokinetics

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO (analgesic)	within 1 hr	unknown	4–6 hr
PO (anti-inflammatory)	days	2–3 wk	days

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• dizziness (most frequent)
• headache (most frequent)
• drowsiness

Ear, Eye, Nose, Throat

• tinnitus
• visual disturbances

Cardiovascular

• edema

Gastrointestinal

• GI bleeding (life-threatening)
• drug-induced hepatitis (life-threatening)
• diarrhea (most frequent)
• dyspepsia (most frequent)
• nausea (most frequent)
• vomiting (most frequent)
• anorexia
• constipation
• discomfort
• flatulence
• stomatitis

Genitourinary

• renal failure

Dermatologic

• hives
• itching

Hematologic

• blood dyscrasias

Miscellaneous

• allergic reactions including anaphylaxis and Stevens-Johnson syndrome (life-threatening)
• drug-induced systemic lupus erythematosus–like syndrome

Interactions

Drug-Drug interaction

Concurrent use with aspirin may ↓ meclofenamate blood levels and may ↓ effectiveness.May ↑ risk of bleeding with thrombolytic agents, cefoperazone, cefotetan, valproic acid, clopidogrel, ticlopidine, eptifibatide, andtirofiban.Additive adverse GI side effects with aspirin, alcohol, corticosteroids, potassium supplements, and other NSAIDs.Probenecid ↑ blood levels and may ↑ 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.↑ bleeding risk with anise, arnica, chamomile, clove, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.

Route/Dosage

Availability (generic available)

Nursing implications

Nursing 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.
• 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.

Potential Nursing Diagnoses

Acute pain (Indications)
Impaired physical mobility (Indications)

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.
• Oral: 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.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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.
• Decreased menstrual flow.