Generic Name

Tolfenamic Acid

Precaution

Patient w/ or w/ history of bronchial asthma, uncontrolled HTN, CHF, established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, coagulation defects, SLE, connective tissue disorders, history of GI disease (e.g. Crohn's disease, ulcerative colitis). Hepatic and renal impairment. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, drowsiness, fatigue and visual disturbances, if affected, do not drive or operate machinery. Monitoring Parameters Monitor renal function.

Indication

Mild to moderate pain, Acute migraine attacks

Contra Indication

Hypersensitivity to aspirin or other NSAID. Active or history of GI bleeding or ulceration, severe heart failure, history of GI bleeding or perforation related to previous NSAID therapy. Severe renal and hepatic impairment. Pregnancy (3rd trimester).

Dose

N/A

Side Effect

Dysuria esp in males; tremor, euphoria, fatigue, pulmonary infiltration, nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, abdominal pain, melaena, haematemesis, ulcerative stomatitis, exacerbation of Crohn's disease and colitis, gastritis, pancreatitis; oedema, HTN, cardiac failure; nephritis, hepatitis, jaundice, abnormal liver function; visual disturbances, optic neuritis, headache, paraesthesia, depression, confusion, hallucinations, tinnitus, vertigo, tremor, dizziness, malaise, drowsiness; thrombocytopenia, neutropenia, agranulocytosis, anaemia. Potentially Fatal: Exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis; GI bleeding, ulceration or perforation.

Pregnancy Category

Mode of Action

Tolfenamic acid, an anthranilic acid derivative, is an NSAID. It has anti-inflammatory, analgesic and antipyretic effects.

Interaction

Increased rate of absorption of tolfenamic acid with metoclopramide and magnesium hydroxide. Decreased rate of absorption of tolfenamic acid with aluminium hydroxide. Increased risk of bleeding with anticoagulants and other NSAIDs. Decreased antihypertensive response to loop diuretics, ?-blockers and ACE inhibitors. Coadmin increased plasma concentrations of lithium, methotrexate and cardiac glycosides. Increased risk of nephrotoxicity with ACE inhibitors, ciclosporin, tacrolimus or diuretics.

Pregnancy Category Note

N/A

Adult Dose

Oral Acute migraine attacks Adult: 200 mg when 1st symptoms appear, may be repeated after 1-2 hr, if necessary. Mild to moderate pain Adult: 100-200 mg tid. Hepatic impairment: Severe: Avoid.

Child Dose

N/A

Renal Dose

Renal impairment: Severe: Avoid.

Administration

Should be taken with food. Take w/ or immediately after meals.