Meclofenamate

INTRODUCTION

Indications

Management of mild-to-moderate pain, including rheumatoid arthritis, osteoarthritis, dysmenorrhea. Management of excessive menstrual flow.

Action

Inhibits prostaglandin synthesis. Therapeutic Effects: Suppression of pain and inflammation.

Adverse Reactions/Side Effects

CNS: dizziness, headache, drowsiness. EENT: tinnitus, visual disturbances. CV: edema. GI: GI BLEEDING, DRUGINDUCED HEPATITIS, diarrhea, dyspepsia, nausea, vomiting, anorexia, constipation, discomfort, flatulence, stomatitis. GU: renal failure. Derm: hives, itching. Hemat: blood dyscrasias. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND STEVENS-JOHNSON SYNDROME, drug-induced systemic lupus erythematosus–like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

• Be alert for signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain. Report these signs to the physician immediately.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for exfoliation, dermatitis, and other severe skin reactions that might indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis). Notify physician immediately if these reactions occur.

• Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's pain and decreasing impairments.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). NSAIDs can increase BP in certain patients.

• Be alert for signs of prolonged bleeding time such as bleeding gums, nosebleeds, and unusual or excessive bruising. Report these signs to the physician.

• Monitor unusual weakness and fatigue that might be due to anemia or other symptoms such as fever, sore throat, mucosal lesions, or signs of infection that might be due to other blood dyscrasias. Notify physician if these signs occur.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor signs of drug-induced lupus syndrome, including increased BP, fever, joint pain, skin rashes, and redness/irritation of the eye (uveitis). Notify physician promptly if these signs appear.

• Monitor signs of kidney dysfunction such as painful urination or blood in the urine. Report signs of renal failure immediately, including decreased urine output, increased BP, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient ...