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At least 19 recordsLinked to original sources

Use of meclofenamic acid in gynecology and obstetrics: effects on postsurgical stress.

Meclofenamic acid has been successfully used in several obstetrical and gynecological disorders sustained by a prostaglandin overproduction. A brief review of meclofenamic acid use for primary dysmenorrhea, menorrhagia, and episiotomy pain is followed by an original study of this compound in postsurgical pain and stress. Thirty gynecological patients undergoing abdominal hysterectomy and 10 pregnant women submitted to cesarean section at term were considered. In gynecological patients, meclofenamic acid suppositories (200 mg) or placebo were given every 12 h during the immediate postsurgical period; pregnant women were given the active drug only. Subjective pain was evaluated [through visual analogue scale (VAS)] in basal conditions (2 h from the end of surgery) and 2, 4, 6, 24, and 28 h from the first drug dose. At the same time, blood was drawn for the evaluation of plasma cortical levels (through coated-tube radioimmunoassay). A significant pain relief was obtained after only 4 h posttreatment both in gynecological patients and pregnant women. Meclofenamic acid was superior to placebo from 6 h after treatment and it almost suppressed subjective pain at the end of the observation period (28th h). Cortisol levels were already high at the basal evaluation and showed a further increase during the first postsurgery hours. Patients treated with meclofenamic acid had cortisol values lower than those who were treated with placebo. The former recovered normal levels after 24 h, whereas the latter already had increased values. These data demonstrate that meclofenamic acid is a safe, powerful and specific analgesic for the postsurgical period. The reduction of pain stimulation is also accompanied by a reduced activation of the neuroendocrine axis with a prompt recovery from postsurgical stress.

Adult

Effects of meclofenamic acid in the treatment of lesions deriving from minor traumatology.

The clinical efficacy and tolerability of topical 5% meclofenamic acid gel versus placebo and oral sodium meclofenamate versus sodium naproxen were evaluated in patients affected with minor traumatologies. Ninety patients were studied: 60 were treated with either meclofenamic acid gel or placebo for 10 days, and 30 were administered with either sodium meclofenamate capsules or sodium naproxen capsules for 7 days. The 5% meclofenamic acid gel and its sodium salt in capsules proved significantly more rapid and efficient than did the reference compounds in reducing pain symptomatology. In the patients treated with 5% meclofenamic acid gel, a greater effect was seen as regards rapidity of spontaneous movement and nocturnal pain reduction. In other variables examined, that is, surface and deep hyperalgesia, and swelling and functional restriction, there was also a significantly higher efficacy than with placebo. Confirmation of the therapeutic efficacy of meclofenamic acid (sodium salt) was obtained with the capsule formulation, that was seen to exert a significant analgesic and antiphlogistic action; the onset of this action was particularly rapid. Both formulations of meclofenamic acid (gel and capsules) were found to be well tolerated. Thus, in the examined formulations, meclofenamic acid proved to be a useful tool in the treatment of lesions in the minor traumatology category.

Administration, Oral

Prostaglandin biosynthesis in rabbit kidney medulla: inhibition in-vitro vs. in-vivo by aspirin, indomethacin and meclofenamic acid.

The non-steroidal anti-inflammatory drugs aspirin, indomethacin and meclofenamic acid were compared for their potency and duration of inhibition of prostaglandin biosynthesis in rabbit kidney medulla. Indomethacin and meclofenamic acid showed equal potency of inhibition in-vitro (IC50 0.88 micron and 0.85 micron respectively) while aspiring was a much weaker inhibitor (IC50 120 micron). In-vivo, indomethacin was the most powerful inhibitor (ID50 0.034 mg/kg) followed by meclofenamic acid (0.45 mg/kg) and aspirin (2.35 mg/kg). Studies on the duration of in-vivo inhibition by these compounds showed the effect of indomethacin and meclofenamic acid to be completely reversed within 4-6 hours. In contrast, return of kidney prostaglandin biosynthetic activity following aspirin inhibition is very slow and significant inhibition is still present 48 hours after a single aspiring injection. The inhibitory effect of aspirin in-vivo could be blocked by pretreatment with indomethacin, indicating that both drugs interact with related sites on the cyclo-oxygenase enzyme. The irreversible inhibition of the cyclo-oxygenase by aspirin as demonstrated in studies of other investigators suggests that the return of kidney prostaglandin synthetase activity after aspirin inhibition represents synthesis of new cyclo-oxygenase protein.

Animals

Use of meclofenamic acid to investigate the role of prostaglandin biosynthesis during induced parturition in sheep.

The maternal administration of meclofenamic acid (a prostaglandin synthetase inhibitor) to pregnant sheep prevented the dexamethasone-induced delivery of live lambs and delayed delivery after foetal death in utero. Administration of meclofenamic acid had no effect on the changes in the levels of progesterone and oestrogen in the plasma which occur before lambing in response to foetal glucocorticoid. Despite normal maternal endocrine changes, increased uterine activity did not occur at the expected time, although it could be elicited by vaginal distension or by administration of oxytocin. The rates of cervical ripening and dilatation were reduced by meclofenamic acid and lambing was frequently associated with some degree of cervical dystocia. Withdrawal of meclofenamic acid did not immediately result in an increase in the level of prostaglandin F in the plasma despite the appearance of co-ordinated uterine contractions; the concentration of prostaglandin in the plasma was not raised until vaginal passage of the lambs. It is concluded that the synthesis or release of prostaglandins mediates the effects of changes in the levels of steroids in the maternal plasma on uterine contractility in sheep.

Animals

Studies of meclofenamic acid and two metabolites in horses--pharmacokinetics and effects on exercise tolerance.

The pharmacokinetics and the effects on treadmill exercise of the anti-inflammatory drug meclofenamic acid were studied in seven Standardbred horses after single intravenous and/or oral doses. The decline in plasma concentration after a single intravenous dose of meclofenamic acid (2.2 mg/kg b.wt) was described by a two-compartment open model. The average elimination half-life was 1.4 h, the apparent volume of distribution 0.14 l/kg and the plasma clearance 0.12 l/h kg. Absorption was the rate-limiting step after oral administration. Non-compartmental analysis showed a mean absorption time of 4.3 h. The pharmacokinetics of two metabolites of meclofenamic acid were also studied in two of the horses. The elimination half-lives of the two metabolites were virtually the same in each horse (3.0 h and 3.4 h). The blood lactate response to exercise was significantly decreased after treatment with meclofenamic acid, indicating a lower utilization of the glycolytic ('anaerobic') energy contribution during exercise. Circulatory capacity was apparently unaffected with an unchanged heart rate response to exercise.

Absorption

Effect of meclofenamic acid on the response of parasite-naive lambs and adult sheep to Ostertagia circumcincta.

Meclofenamic acid was used to inhibit prostaglandin synthesis in lambs challenged with Ostertagia circumcincta. It lowered the number of parasites which established in treated animals but not significantly. In treated animals plasma pepsinogen values were elevated at the time of parasite emergence but had dropped below the values achieved in control lambs towards the end of the experiment when parasites were at the adult, lumenal dwelling stage. Meclofenamic acid administered to adult immune ewes during challenge with third stage O circumcincta larvae did not significantly affect the establishment of the parasites, nor did it affect the rise in pepsinogen concentration associated with the challenge.

Abomasum

Effects of topical applications of meclofenamic acid and ibuprofen on bone loss, subgingival microbiota and gingival PMN response in the primate Macaca fascicularis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to alter periodontitis in both animals and humans. This study was initiated in the nonhuman primate (Nhp) model to determine the effect of two NSAIDs on preexisting gingivitis, the conversion of gingivitis to periodontitis, the associated subgingival microbiota, and the gingival PMN response. Eighteen cynomolgus monkeys were divided into three groups and treated on a blind basis with ibuprofen 8%, meclofenamic acid 5%, or placebo applied topically 5 days/week for 20 wk. After 4 wk of treatment, periodontitis was initiated in one quadrant by the placement of silk ligatures. Clinical parameters, bone loss by densitometric analysis of radiographs (CADIA), and cultural microbiology of subgingival plaque were monitored. In situ PMN chemotaxis was assessed by quantitating the PMNs which entered the sulcus in response to a challenge with n-formyl-methionyl-leucyl-phenylalanine (FMLP). No significant differences in the clinical parameters were noted by treatment groups. Radiographic bone loss was detected in all experimental sites in placebo animals as compared with 67% and 44% for ibuprofen and meclofenamic acid animals, respectively. Mean CADIA scores/animal showed a significant loss in bone density for placebo at 6 and 16 wk, no change for ibuprofen animals, and a significant increase in density for meclofenamic acid animals. The microbiota of all groups changed with ligation consistent with previous reports of disease initiation in the Nhp.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical

Inhibition of prostaglandin F2alpha-induced reflex bradycardia and hypotension by meclofenamic acid.

Intravenous injection of prostaglandin F2alpha (4-15 mug/kg, i.v.) produces an increase in pulmonary arterial pressure in conjunction with reflex bradycardia and hypotension in the anesthetized cat. Meclofenamic acid (30 mg/kg, i.v.) inhibited the bradycardia and the reflex contribution to the systemic hypotension. Neither the PGF2alpha-induced pulmonary vasoconstriction nor the direct systemic vasodilator actions of PGF2alpha were blocked by meclofenamate. In addition, the reflex responses caused by i.v. veratrine and 5-HT were not inhibited by meclofenamate. These results suggest that meclofenamic acid selectively blocks the afferent mechanism by which PGF2alpha induces reflex bradycardia and hypotension in the cat.

Animals

The topical anti-inflammatory effects of a topical preparation of meclofenamic acid on carrageenan-induced footpad swelling in mice.

A topical preparation of meclofenamic acid (Meclomen) was tested for anti-inflammatory activity in a murine model of carrageenan footpad oedema. The preparation significantly inhibited swelling when applied to the carrageenan-injected paw. Maximum inhibition was observed 4-5 h after carrageenan injection. The topical effects could not be attributed to systemic absorption because the preparation was more inhibitory when applied topically to the carrageenan-injected paw than to a distant site or orally.

Administration, Oral

Uterine cavity and the location of IUDs following administration of meclofenamic acid to menorrhagic women. A pilot study.

The relationship between the uterus and the IUD was studied selectively with hysterosalpingograms in 18 menorrhagic women previously treated with Meclofenamic acid (M Ac.), a well known anti-inflammatory drug. Major anomalies (embedding, perforation, rotation) were found in 28.6% of those patients who responded positively to M Ac. In contrast, major anomalies were found in 63.6% of those patients who responded negatively to the drug. It is proposed that the negative response to M Ac. might be due to severe macroscopic disturbances of the uterine wall-IUD relationship. The degree of response to M Ac. might contribute to the decision to remove the IUD from menorrhagic women. In addition, 84.7% anomalies (deformities, embedding, perforation) in the uterine-IUD relationship were found in 13 women with a T-shape IUD device. The fact that those anomalies are related to the tip of the horizontal arm justifies future studies using shortened arms to diminish hypermenorrhea induced by T-shape devices or attempts to use IUDs which do not have the conventional plastic frame, as in the Cu-Fix IUD which has been mentioned as particularly useful to prevent bleeding side effects and pain induced by conventional IUDs. The Cu-Fix IUD consists of 6 sleeves made of pure (99.99%) copper, each sleeve with a length of 5 mm and an outer diameter of approximately 2.2 mm, threaded on surgical 00 monofilament polypropylene (ProleneR, Ethicon). The total area of exposed copper is approximately 390 mm2. The sleeves are prevented from sliding off the suture by 2 smaller copper tubules crushed on the thread in both ends of the IUD structure. This thread-type, copper-bearing device has been designed to overcome the most common IUD-related problems, bleeding and pain.

Adolescent

Recent acquisitions in pain therapy: meclofenamic acid.

A better utilization of nonsteroidal anti-inflammatory drugs (NSAIDs) is possible today based on recent pharmacodynamic and pharmacokinetic studies. The analgesic action of these drugs may take place in the central nervous system (CNS). The analgesic action with a lower dose occurs earlier than the anti-inflammatory action. Some NSAIDs cause an increased level of plasmatic bendorphines in humans. NSAIDs not only have antiprostaglandin action, but also may block the release of substance P. The NSAIDs may be useful for headache, dysmenorrhea, rheumatic disease and in cancer pain therapy. For the safe use of NSAIDs the previous anamnestic and clinical features of the patient must be considered, and a high therapeutic level must be satisfied. Considering this goal, the authors examine pharmacologic and clinical behavior of meclofenamic acid.

Animals

Interactions between oleic acid and drug competitors influence specific binding of thyroxine in serum.

Long chain nonesterified fatty acids and various drugs may share albumin-binding sites in common. We questioned whether serum binding of T4 could be indirectly influenced by displacement of drug competitors from these sites by nonesterified fatty acids. The influence of oleic acid on drug-induced inhibition of [125I]T4 binding was measured by equilibrium dialysis, using undiluted serum in order to avoid dilution-related artefacts. Oleic acid (1 mmol/L) alone did not inhibit serum protein binding of T4, but this concentration augmented the inhibitory effects on T4 binding of diflunisal, mefenamic acid, meclofenamic acid, and aspirin. This effect increased with increasing concentrations of mefenamic acid, meclofenamic acid, and furosemide. The T4-displacing effect of fenclofenac was not augmented by oleic acid. The mechanism of these interactions was studied by examining 1) oleic acid effects on drug binding, and 2) drug effects on oleic acid binding in undiluted serum. Increments in added oleic acid (0.5-2.0 mmol/L) progressively increased the mean unbound fractions of [14C]aspirin, [14C] diflunisal, and [14C]furosemide, but did not displace [14C]fenclofenac. At the relevant total and free drug concentrations, the inhibitory effect of oleic acid on drug binding and its influence on drug-induced displacement of T4 were concordant in the order: meclofenamic acid greater than aspirin greater than mefenamic acid greater than diflunisal greater than furosemide greater than fenclofenac. In contrast, drug-induced increases in the unbound fraction of [14C]oleic acid did not correlate with augmentation of T4 displacement. We conclude that synergistic effects of oleic acid and drugs on T4 binding result from drug displacement by oleic acid, rather than the reverse effect. Hence, substances that increase the unbound concentration of a competitor by displacing it from albumin can increase its T4-displacing potency. Interactions between various ligands may exert a greater hormone-displacing effect than the sum of each alone.

Anti-Inflammatory Agents, Non-Steroidal

A single and multiple dose pharmacokinetic and metabolism study of meclofenamate sodium.

A single and multiple oral dose administration study of meclofenamate sodium (Meclomen) was conducted in ten healthy male volunteers. An initial 300 mg oral dose on day 1 was followed by a 100 mg every 8 h dosage regimen on study days 4 through 18. Intensive plasma and urine sample collection was carried out over the first three study days, and for 120 h following administration of the final dose on day 18. Plasma and urine specimens were analyzed by a specific HPLC assay for unconjugated meclofenamic acid and metabolites I and II of meclofenamic acid before and after sample incubation with beta-glucuronidase. Meclofenamic acid was rapidly absorbed following oral dose administration. Concentrations of meclofenamic acid existed primarily as unconjugated drug in plasma, with only a small amount present in the conjugated form. Meclofenamic acid was rapidly eliminated, with an elimination half-life of approximately 1.3 h. This resulted in no detectable accumulation upon multiple dose administration. Metabolite I, which is one-fifth as active as meclofenamic acid in in vitro inhibition of cyclooxygenase, was present in unconjugated form at steady state in concentrations approximately 50 per cent of those of meclofenamic acid, as unconjugated drug. The majority of metabolite I in plasma existed as glucuronide conjugate. Metabolite II, which is inactive, was present in very significant concentrations in unconjugated form. Plasma protein binding determinations conducted on meclofenamic acid and metabolite I indicated that the free fraction of metabolite I was 8.7 to 10.9 times higher than that of meclofenamic acid. When the lower activity and lower steady state concentrations, but higher free fraction, are considered, it would appear that metabolite I may contribute significantly to the in vivo inhibition of cyclooxygenase activity seen after administration of meclofenamic acid.

Adult

Pharmacology, pharmacokinetics, and therapeutic use of meclofenamate sodium.

Meclofenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) approved for use in arthritis (osteo and rheumatoid), analgesia (mild to moderate pain), dysmenorrhea, and heavy menstrual blood loss (menorrhagia). At least three different biochemical effects have been defined for meclofenamic acid. It is a potent inhibitor of the enzyme cyclooxygenase, thereby inhibiting the production of prostaglandins. It also inhibits the release of 5-HETE and LTB4 from human neutrophils stimulated with calcium ionophore and antagonizes the response of tissues to certain prostaglandins. These mechanisms may explain in part the pharmacological profile and clinical effectiveness of this compound. The rapid onset of activity of meclofenamic acid and its duration of action may be the result of its pharmacokinetic profile. Sodium meclofenamate is completely bioavailable from capsules relative to an oral suspension dosage form. Maximum meclofenamic acid plasma concentrations are achieved in 0.5-2 h following doses of capsules. Meclofenamic acid is extensively metabolized. One of the metabolites, metabolite 1, is approximately 20% as active as the parent compound in inhibiting cyclooxygenase activity in vitro. This metabolite accumulates in plasma during repeated dosing. It is possible that this metabolite may contribute to at least some of the activity observed following administration of sodium meclofenamate.

Anti-Inflammatory Agents, Non-Steroidal

Human monocytes exposed to Biostim (RU 41740) alter lymphocyte mitogenesis: mechanisms of action.

The immunomodulatory agent RU 41740 (Biostim), which is derived from Klebsiella pneumoniae, may augment mitogenic responses of purified human blood lymphocytes. In non-purified preparations, however, responses may be sharply reduced due to the fact that Biostim induces monocytes to secrete immunosuppressive factors. This investigation has shown that both these biological activities can be exerted by a single, major glucoprotein fraction of Biostim termed F1. The Biostim-induced suppression of mitogen responses was not blocked by antibodies directed against IFN alpha or IFN gamma, thus speaking against IFN as being a mediator of suppression. Reduced suppression, however, was observed in the presence of drugs which inhibit arachidonic acid transformation. The cyclo-oxygenase inhibitors meclofenamic acid and indomethacin, which diminish biosynthesis of prostaglandins, could partially block the Biostim-induced suppression. Such an effect was not observed with 5,8,11-eicosatrynoic acid (ETI) which is an inhibitor of 12-lipoxygenase and leukotriene biosynthesis. Combinations of ETI and meclofenamic acid, however, were more potent than the latter tested separately. Another drug termed diclofenac Na, which apart from being an inhibitor of cyclo-oxygenase, rapidly clears cells of free arachidonic acid by binding to triglycerides, was found to be the most potent in preventing Biostim-induced suppression of mitogen responses. It is concluded that Biostim-exposed monocytes liberate increased amounts of immunosuppressive eicosanoids such as prostaglandins.

Adjuvants, Immunologic

Clinical experience in the treatment of dental pain.

Good dental analgesia requires drugs that are endowed with strong and fast activity and that are well tolerated. In addition, optimal analgesia should essentially be of the peripheral type, thereby eliminating the risk of sedation that may cause unpleasant effects on the patient's daily life. Meclofenamic acid is among those substances whose analgesic effect is more evident than that of anti-inflammatory action. The mechanism of action of meclofenamic acid makes it distinctly different from other nonsteroidal anti-inflammatory drugs (NSAIDs) in that it inhibits the metabolic pathways of arachidonic acid and, at the same time, antagonizes the effects of prostaglandins at the peripheral receptor level. A number of controlled clinical trials showed that meclofenamic acid is an excellent analgesic, offering good tolerability when used in oral surgery, dysodontiasis, avulsion of the third impacted molar, and periodontitis. The following report is a presentation of results obtained in a controlled clinical trial in which the speed of pain relief was assessed in 20 patients suffering from acute periodontitis. The patients were treated orally with a single dose of meclofenamate sodium (100 mg) or with piroxicam-beta-cyclodextrin (20 mg). The intensity of the drug's analgesic effect was measured at 0.5, 1, 2, 4, and 6 h after administration. After initial testing, meclofenamate sodium was found to be significantly more effective than piroxicam-beta-cyclodextrin. Both the physician and patient found this drug to be considerably better. Pain relief after treatment with meclofenamate sodium was clinically and statistically faster than piroxicam-beta-cyclodextrin, and both drugs were found to be well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Melittin-induced changes in Na and Cl movements across the skin and cornea (in vitro) of the toad Bufo marinus.

Melittin, from bee venom, increases short-circuit current (Isc) across the skin and cornea of toads. In skin this reflects a rise in the influx of Na and is inhibited by meclofenamic acid (inhibits prostaglandin synthetase). In corneas with melittin on the inside the rise in Isc is inhibited by bumetanide (inhibits Cl transport) and meclofenamic acid. Melittin on the tear side of the cornea causes a biphasic change in Isc, and a rise in all undirectional fluxes of Na and Cl. This effect was not changed by bumetanide or meclofenamic acid. Melittin apparently has two types of effects, one mediated by prostaglandins while the other is more direct.

Amphotericin B