Tolfenamic Acid

Tolfenamic Acid is a nonsteroidal anti-inflammatory drug (nsaid) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Acute treatment of migraine attacks in adults, when prescribed.
• Short-term relief of mild to moderate pain and inflammatory conditions where an NSAID is considered suitable.
• Menstrual pain may be treated with NSAIDs such as Tolfenamic Acid when specifically advised by a doctor.

Adult dosing depends on the condition being treated, the dosage form, and the patient’s risks. Use the lowest effective dose for the shortest possible time. Tablets are usually taken with or after food to reduce stomach irritation. Injection should be given only by a trained healthcare professional. Follow the exact dose and duration prescribed by the doctor; do not self-increase the dose or combine with other painkillers without advice.

• Common: nausea, indigestion, abdominal pain, diarrhoea, dizziness, headache, and skin rash.
• Stomach irritation, ulceration, or bleeding may occur; seek urgent help for black stools, vomiting blood, or severe abdominal pain.
• Serious but less common: allergic reactions, asthma worsening, swelling, high blood pressure, kidney problems, liver enzyme changes, and severe skin reactions.
• NSAIDs may slightly increase the risk of heart attack or stroke, especially with higher doses, longer use, or existing cardiovascular disease.

Use caution in people with a history of stomach ulcer or bleeding, asthma, heart disease, high blood pressure, kidney or liver disease, dehydration, bleeding disorders, or in elderly patients. Avoid alcohol and avoid using multiple NSAIDs together unless specifically advised. Use under the guidance of a registered doctor or pharmacist, and seek medical advice if symptoms persist or worsen.

• Other NSAIDs, including high-dose aspirin: increased risk of side effects and bleeding.
• Anticoagulants and antiplatelet medicines such as warfarin, heparin, clopidogrel, and low-dose aspirin: increased bleeding risk.
• Corticosteroids, SSRIs, and SNRIs: increased risk of gastrointestinal bleeding.
• ACE inhibitors, ARBs, and diuretics: reduced blood pressure control and increased kidney risk.
• Lithium, methotrexate, and digoxin: levels or toxicity may increase.
• Cyclosporine or tacrolimus: increased kidney toxicity risk.
• Alcohol: increased stomach irritation and bleeding risk.

• Known allergy to tolfenamic acid, other fenamates, or any component of the product.
• History of asthma, urticaria, or allergic-type reaction after aspirin or another NSAID.
• Active or recurrent peptic ulcer, gastrointestinal bleeding, or perforation.
• Severe heart failure, severe kidney impairment, or severe liver impairment.
• Use during the third trimester of pregnancy.
• Use for pain around coronary artery bypass graft surgery.

Tolfenamic Acid should be avoided in pregnancy unless a doctor decides it is necessary. NSAIDs are generally avoided from around 20 weeks of pregnancy because of fetal kidney and fluid risks, and they must not be used in the third trimester due to risks such as premature closure of the ductus arteriosus and bleeding complications. Breastfeeding data are limited; use only on medical advice, and an alternative medicine may be preferred.

Store in a cool, dry place away from direct sunlight and moisture. Keep out of the reach of children. Do not use after the expiry date, and do not use an injection if the solution is discoloured, cloudy, or the container is damaged.