Indications

Etuf is used to:

• Relieve the pain of migraine headaches.
• As an analgesic for post-operative pain and fever.

Pharmacology

Tolfenamic acid, a fenamate, is a potent inhibitor of the cyclooxygenase enzyme. This action prevents the synthesis of inflammatory mediators like thromboxane (TXB2​) and prostaglandin (PGE2​), which are responsible for pain, swelling, and inflammation. Tolfenamic acid also acts as a direct antagonist on prostaglandin receptors. It is readily absorbed, with a bioavailability of 85% and a plasma half-life of 2 hours. It is metabolized in the liver and undergoes enterohepatic circulation, with excretion through both urine (90%) and feces.

Dosage & Administration

• Adults:
  • Acute migraine attacks: 200 mg when symptoms appear, which can be repeated once after 1-2 hours.
  • Mild to moderate pain: 100-200 mg three times daily (tid).
• Renal Impairment: Dose adjustments may be necessary. Use should be avoided in cases of severe renal impairment.
• Children: A pediatric dosage has not been established. Etuf should be taken with food and water during or immediately after meals.

Interaction

• With other medications:
  • Metoclopramide and Magnesium hydroxide: Increase Etuf's absorption rate.
  • Aluminium hydroxide: Decreases Etuf's absorption rate.
  • Anticoagulants and other NSAIDs: Increase the risk of bleeding.
  • Loop diuretics, $\beta$-blockers, and ACE Inhibitors: Etuf decreases their antihypertensive effects.
  • Lithium, Methotrexate, and cardiac glycosides: Co-administration increases their plasma concentration.
  • ACE inhibitors, Ciclosporin, Tacrolimus, or diuretics: Increase the risk of nephrotoxicity.

Contraindications

Etuf is contraindicated in patients with:

• Active gastrointestinal bleeding or ulceration.
• A history of gastrointestinal bleeding or perforation related to previous NSAID therapy.
• A history of recurrent gastrointestinal ulceration.
• Severe heart failure.

Side Effects

Reported side effects include:

• Rare: Alveolitis, hepatic damage, pancreatitis, pulmonary eosinophilia, Stevens-Johnson syndrome, angioedema, and blood disorders.
• Common: Depression, diarrhea, dizziness, drowsiness, dysuria (painful urination), euphoria, gastrointestinal bleeding, nausea, hearing or visual disturbances, vertigo, and raised blood pressure.

Pregnancy & Lactation

This medicine is not recommended during pregnancy unless considered essential by a doctor and should not be given during the third trimester. NSAIDs can appear in breast milk in very low concentrations and should be avoided if possible while breastfeeding.

Precautions & Warnings

Caution is needed for patients with asthma, bronchospasm, bleeding disorders, cardiovascular diseases, peptic ulceration, hypertension, liver or renal function impairment, and for elderly patients. Increased water intake or a dose reduction may help to reduce dysuria.

Overdose Effects

Overdose symptoms may include headache, nausea, vomiting, epigastric pain, gastrointestinal bleeding, drowsiness, dizziness, and occasionally convulsions. In significant poisoning, acute renal failure and liver damage are possible. Treatment is symptomatic and supportive.

Therapeutic Class

Etuf is classified as a drug used for rheumatoid arthritis, a non-steroidal anti-inflammatory drug (NSAID), and a drug for migraine.

Storage Conditions

Store in a cool and dry place, away from light. Keep out of the reach of children.