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Pathogenesis of Fever & its Management with MEFTAL

Mefenamic Acid

Mefenamic Acid, an N (2,3-xylyl) anthranilic acid, was initially released in 1962 for pharmaceutical purposes and was marketed in several countries.

t is available in many European and South-East Asian countries, including India.

The drug possesses anti-pyretic, analgesic, and anti-inflammatory properties.

One of the most highly cited drugs in the existing scientific and medical literature, fenamates are one of the most highly studied drugs.

Mechanism of Mefenamic Acid

Uniqueness of Mefenamic Acid

Unique NSAID (Non-steroidal anti-inflammatory drugs) with a plethora of
physiological effects, clinically helpful for its anti-pyretic, analgesic, and
anti-inflammatory effects.

In addition to PG synthesis inhibition, what is unique about Mefenamic Acid is its ability to block the E-type prostanoid (EP) receptors, thus blocking the pre-formed PGs as well.

It is a competitive, time-dependent, and reversible inhibitor for COX-1 and COX-2.

It is the only anti-pyretic with dual action on COX inhibition (central and peripheral mechanisms) and NLRP3 inflammasome inhibition.

Efficacy and Safety

This study showed that the NLRP3 inflammasome inhibitory action of Mefenamic Acid may attenuate the levels of Pyrogenic Cytokines (IL-1β).1
A case series including 71 patients from 3 months to 15 years of age showed that Mefenamic Acid given in a 4 mg/Kg dose resulted in optimal anti-pyretic effect. 5
The anti-pyretic effect was 2.5 times that of Paracetamol. 5

References

  1. Liu Z, Xian H, Ye X, Chen J, Ma Y, Huang W. Increased levels of NLRP3 in children with febrile seizures. Brain Develop. 2020; 42:336-41.
  2. Reddy GT, Gobbur RH, Patil SV. Randomized open-label study to compare the safety and efficacy of Paracetamol, Ibuprofen, and Mefenamic Acid in febrile children. Int J Sci Study. 2020; 8:58-62
  3. Feng X, Wang X. Comparison of the efficacy and safety of non-steroidal anti-inflammatory drugs for patients with primary dysmenorrhea: A network meta-analysis. Mol Pain. 2018;14:1744806918770320.
  4. López Bernal A, Buckley S, Rees CM, Marshall JM. Meclofenamate inhibits prostaglandin E binding and adenylyl cyclase activation in human myometrium. J Endocrinol. 1991;129(3):439-45.
  5. Similä S, Kouvalainen K, Keinänen S. Oral anti-pyretic therapy. Evaluation of Mefenamic Acid (short communication). ArzneimittelForschung. 1977;27(3): 687-8.
  • Mefenamic Acid is considered to be one of the safest NSAIDs and has superior efficacy compared to Nimesulide, Rofecoxib, Valdecoxib, Aspirin, Flurbiprofen, Ibuprofen, Indomethacin, Ketoprofen, Naproxen, and Piroxicam. 1
  • In prospective studies less than 5% of patients taking Mefenamic Acid experienced transient serum aminotransferase rise. The abnormalities were self-limiting in nature and usually resolved even while continuing the drug without any dose modifications. 2
  • Mefenamic Acid should not be used during the first trimester of pregnancy, can be given in the second trimester and is not recommended after 30 weeks of gestation. 3
  • Use of Mefenamic Acid is contraindicated in patients with pre-existing renal disease/renal impairment and should be avoided in patients with advance liver disease. 4
  • It is compatible with breastfeeding. 4

References

  1. [Ref: Feng X, Wang X. Comparison of the efficacy and safety of non-steroidal anti-inflammatory drugs for patients with primary dysmenorrhea: A network meta-analysis. Mol Pain. 2018; 14:1744806918770320.
  2. [Ref: INTERNET. Mefenamic Acid. In LiverTox: Clinical and research information on drug-induced liver injury. January 10, 2020. Accessed on November 2, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK548029/]
  3. [Ref: Asif M. Am. J. Med. Stud. 2014; 2(1): 24-30, https://www.uktis.ora/www/medicinesinpregnancy.org]

Mefenamic acid is
Standardized & Published in
Pharmacopoeias
all over the world

European Pharmacopoeia 9.0
British Pharmacopoeia 2019
The Japanese Pharmacopoeia Seventeenth Edition
Indian Pharmacopoeia 2018 Volume 1
U.S Pharmacopoeia USP 48 NF 43
PEDIATRIC FEVER
MANAGEMENT OF FEVER
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Never Self-Medicate