Indiscriminate usage of ‘harmless’ painkillers can cause GI bleeding, liver damage

Hyderabad: After the Indian Pharmacopoeia Commission (IPC) issued a drug safety alert for healthcare professionals and patients regarding the adverse reactions of painkiller Meftal, medical experts from the city have also cautioned about indiscriminate and non-prescribed intake of painkillers, especially the non-steroidal anti-inflammatory drugs (NSAIDs).

The Indian public tends to pop in painkillers considering them to be ‘just a harmless painkiller,’ while medical outlets add to this habit by selling them as over-the-counter (OTC) medication without any discretion.

The IPC is an autonomous institution of the Ministry of Health and sets standards for all drugs that are manufactured, sold and consumed in India.

Alert about Meftal painkiller

The Mefenamic acid painkiller is used in the treatment of ailments such as rheumatoid arthritis, osteoarthritis, dysmenorrhoea (menstrual cramps), mild to moderate body pain, inflammation, fever and dental pain.

The IPC, in its alert, stated that a preliminary analysis of adverse drug reactions from the Pharmacovigilance Programme of India (PvPI) database revealed drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome.

What is DRESS syndrome?

After taking Mefenamic acid or Meftagesic (in combination with paracetamol), one may experience Dress Syndrome, which refers to rashes and severe systemic symptoms causing a lot of problems for the patients. Many other drugs belonging to the same group like Ibuprofen can also cause Dress Syndrome though it is extremely rare, said paediatrician Dr Sivaranjani Santosh.

“Especially when it comes to medication for fever in children, parents should stick to paracetamol as much as possible, giving the correct dosage and maintaining the correct interval between drugs. In case the fever is uncontrolled with paracetamol, then Ibuprofen can be administered judiciously only after checking with the paediatrician regarding the correct dosage,” the doctor said.

“All these NSAIDs can suppress platelets and cause bleeding in the stomach and gastritis or stomach acidity and can also affect the kidneys if overused. When overused, Mefenamic acid can also increase the risk of seizures,” cautioned Dr Sivaranjani.

Giving more information on the harm caused by NSAIDs, general physician Dr Saketha Reddy said, “Mefenamic acid has the potential to damage the lining of the stomach. Certain mechanisms in case of prolonged and improper use can inhibit the protective layer of the stomach causing ulceration and bleeding.”

Adverse reactions from other NSAIDs/painkillers

“Similarly, another NSAID called Diclofenac, commonly used to alleviate body and joint pains can also display adverse side effects such as nausea, an upset stomach, increase in blood pressure, severe acidity, gastrointestinal bleeding in patients who already have ulcers,” said Dr Reddy.

“A few years ago, the OTC sale of NSAID like Disprin was banned as it was found to cause side effects like nausea and vomiting on long-term usage and was not safe for dengue patients. Even the safest drug paracetamol can cause liver damage if taken more than four grams a day. For children, NSAIDs are prescribed in low dosage while aspirin is not recommended for kids as they may cause Reye’s Syndrome (characterised by brain swelling and liver damage),” he added.

Be mindful of dosage and contraindications

“People mistakenly think that these drugs are harmless and to alleviate pain, and they keep on taking them, without minding the gaps between the tablets, dosages and other comorbidities and contraindications. Pharmacists also do not explain the cautions that one must exercise while consuming these drugs, nor tell patients about the right dosage or contraindications. Therefore, their long-term and improper intake can cause various adverse side effects,” the doctor said.

Report adverse side effects

In case of a reaction due to Meftal, the IPC alert encourages people to report the matter to the national coordination centre of the PvPI under the commission by filing a form on the IPC website or through the Android mobile app ADR PvPI or calling the PvPI Helpline number 1800-180-3024.