Advisory that almost killed a painkiller

CHENNAI: Ask any woman about her periods, and many would narrate a tale filled with debilitating pain and exhaustion. Painkiller Meftal was a much-needed intervention that helped them cope with it each month.

But recently, this painkiller was caught in a controversy when the Indian Pharmacopoeia Commission raised concerns over the risks associated with mefenamic acid, which is an active ingredient in Meftal 500 tablets.

Mefenamic acid has been linked to severe allergic reactions, and this led to a lot of misinformation about the use of Meftal. The advisory stated that use of mefenamic acid can have a potentially adverse effect in the form of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome.

This made women rethink their choice of painkillers, and also prompted many pharmacies and medical shops to stop stocking them, in anticipation of a ban.

However, obstetrics and gynaecologists in the city opined that the advisory was taken out of context, which led to so much speculation and misinformation that were amplified on social media.

Unnecessary panic

Meftal is one of the most common pain relief tablets available in the market that’s commonly used for menstrual cramps.

“We’ve been using the tablet even after the advisory was released as it did not say that the drug cannot be used but should be given with caution. We’re explaining the side-effects of taking Meftal to patients as listed in the advisory so that they can report to us if they develop any symptoms,” said Dr Irfana Shahul Hameed, gynaecologist, Motherhood Hospital.

She added that the common side-effects are fever or rashes, which could occur 2-3 weeks after taking the medication but it was quite rare. “You should not self-diagnose and consult a doctor if side-effects occur,” she stated. “Since patients raised concerns after reading media reports on the adverse side-effects, we’ve been explaining that the advisory was about mefenamic acid, which is present in many drugs, and not just Meftal.”

Pharmacists in the city have also witnessed a drop in the sale of the drug in the last one month. “There are alternatives available now to reduce period pain but the advisory definitely affected the sales of the product,” stated Natraj, a pharmacist in Adyar.

Misinformation on social media

Amplification about the advisory and its related misinformation flooded social media platforms, with all kinds of messages, posts and videos saying that consuming Meftal had irreversible side-effects.

Clarifying some of these claims to DT Next was Dr Cyriac Abby Philips, popularly known as @theliverdoc on X (formerly Twitter), who stated that DRESS syndrome was well-known but an extremely rare occurrence associated with all painkillers that had mefenamic acid.

“The most common drugs that lead to DRESS syndrome are anti-seizure medications (almost 50% cases reported world-wide) such as carbamazepine, phenytoin and phenobarbitone, antibiotic such as minocycline and the drug given for gout, called allopurinol. Carbamazepine anti-seizure drug has been reported to be implicated in most DRESS cases world over — 27% of all reported cases. Non-steroidal anti-inflammatory drugs causing DRESS syndrome, which was reported worldwide, make up hardly 3-5% of cases. Of this, indomethacin (a painkiller seldom used nowadays) is the most commonly implicated, but not mefenamic acid,” he elaborated.

Though awareness has increased about several medications and their side-effects in the digital era, there is information overload, which is why crucial messages are often missed.

Case in point is the advisory, which only warned people of DRESS syndrome caused by the use of mefenamic acid, which is an ingredient in many medications, and not just Meftal.

“It’s just that Meftal is so common that people associate it with the advisory. There can be a risk of DRESS syndrome but the chances are very low,” pointed out Dr Samhitha, consultant obstetrician and gynaecologist, Prashanth Hospitals. “Patients don’t realise that many antibiotics, anti-epileptic and anti-seizure drugs can also cause the same symptoms. The advisory was taken out of context and misinformation led to a lot of forwards, viral videos and posts.”

Budget-friendly alternatives

Women are now choosing heating pads, home remedies, hot water bags, other pills and drugs to manage period pain. However, the cost factor of Meftal and the immediate effect it has on cramps makes it a natural first-choice.

“It’s around Rs 50 for a strip of Meftal, so much cheaper than other products and easily accessible too. Medications to ease cramps are now made popular but most are only available online. This is why I prefer Meftal,” explained Jyotsana (30), an IT professional.

Indians, even the younger tech-savy ones, are not always comfortable taking long-term allopathy medications. The fear of complications has them look for other options.

“I’ve been taking Meftal, 2 tablets/day, for the past 7-8 years. Nothing else works for my cramps. I’m looking for alternatives because I’m scared of any complications due to long-term consumption of modern drugs,” said Deepika P (27), another techie in the city.

However, doctors explained that those who have been consuming mefenamic acid for years are less likely to have such allergic reactions, as the body would have been used to it. “The advisory was not meant for the general public but for pharmacological experts for them to understand that DRESS syndrome is a risk, which was earlier not known. It was taken out of context,” clarified Dr Samhitha.

Lack of awareness

The advisory scared women, in particular, as the only drug they knew to have had mefenamic acid was Meftal. Though it mentions side-effects, it does not refer to any age-group or gender that could be at a higher risk.

“A lot of women asked me for other alternatives as soon as the news was out. Any drug can have long-term impact; even non-medicating materials can be helpful to reduce the pain,” stated consultant obstetrician and gynaecologist Dr Arvind Santhosh. “Women need better access to a healthcare system that enables them to address menstrual pain without shame or guilt. Since women’s health is taken for granted, it increases their dependency on a particular drug such as Meftal. This is what led to this whole scare on this advisory.”

While such advisories are not uncommon, pharmacists averred that the common public should not be interpreting these alerts without consulting with their physicians. S Ramachandran, former secretary of Tamil Nadu Druggists and Chemists Association, pointed out that the advisory did not mention any particular brand of medicine but many do buy Meftal over the counter.

“Yes, the misinformation did create a lot of confusion,” he admitted. “People who take over-the-counter drugs are looking for alternatives because many do not consult a doctor. They do not have the right information about this advisory.”