Mefarex-D Tablets are used to treat the following:

• For the treatment of functional bowel/irritable bowel syndrome including Colicky abdominal pain.
• Pain after childbirth.
• Period pain or abnormally heavy periods.

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Mefarex-D Tablets should preferably be taken with or after food. Do not drink alcohol whilst taking Mefarex-D Tablets. Alcohol and smoking may irritate the stomach and make some side effects worse.

Adults and the elderly: The usual dose is one tablet, three times a day. Elderly patients are at a higher risk of side effects and should take the lowest effective dose, for the shortest possible time. Your doctor may perform additional monitoring.

Use in children: Mefarex-D Tablets are not suitable for children under the age of 12 years.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes any herbal medicines and medicines obtained without a prescription. Mefarex-D Tablets may affect other medicines and other medicines, in turn, may affect how well Mefarex-D Tablets work.

Tell your doctor or pharmacist if you are taking:

• medicines which can increase the chances of bleeding in the stomach or gut, or increase the risk of getting ulcers such as
  • medicines used to treat arthritis and inflammation (corticosteroids);
  • medicines used to thin the blood (anti-platelet drugs such as warfarin, aspirin, clopidogrel);
  • anti-depressant medicines such as paroxetine, which are selective serotonin re- uptake inhibitors (SSRIs);
  • medicines which are anti-inflammatory, such as diclofenac, celecoxib;
• aspirin, used in some heart conditions to stop your blood from clotting;
• medicines used to treat high blood pressure, such as atenolol, ramipril, valsartan;
• water tablets (diuretics), or medicines for the heart, such as digoxin, diltiazem, sotalol;
• medicines used to treat diabetes, such as glibenclamide, glipizide;
• medicines used to suppress the immune system, such as ciclosporin, methotrexate, tacrolimus;
• medicines used to treat some types of depression, and mood swings, such as lithium;
• a medicine called mifepristone which has been taken within the last 12 days. This is usually prescribed via hospitals;
• quinolone or aminoglycoside antibiotics, used to treat infections;
• zidovudine, used for HIV;
• probenecid, used in special situations to protect the kidneys;
• medicines which bind to protein in the blood (check with your pharmacist).

Like all medicines, this medicine can cause side effects, although not everybody gets them. Stop taking Mefarex-D Tablets if you experience any of the following reactions, and seek medical help immediately:

Allergic reactions: Difficulty in swallowing or breathing, swelling of the face, lips, throat or tongue; severe skin itching with a red rash or raised bumps; blistering of the eyes, mouth, or genital area, with patch areas of peeling skin or rash;

Other reactions: Diarrhea; passing blood in your faeces (stools), or tar-like black faeces; vomiting blood or dark particles which look like coffee grounds;

Seek immediate medical attention if you have any of the below symptoms: indigestion or heartburn, pain in your stomach or abdominal area, feeling sick (nausea), vomiting; unusual bleeding or bruising, such as nose bleeds, pinpoint red spots on the skin, purple bruise-like rash in the mouth or on the skin; feeling tired, breathless or looking pale, which may be signs of anaemia; fever, sore throat, mouth ulcers, repeated or persistent infections, which may be signs of low levels of white blood cells; seizures (fits); headache, nausea, vomiting, tiredness or muscle cramps which may be signs of low sodium levels; sudden headache, stiff neck, fever, sensitivity to bright lights, drowsiness, muscle pain, with or without rash; fever, rash, nausea, aches or pains, changes in amount of urine passed, passing red urine, passing urine at night, which may be signs of changes in your kidneys; sudden loss of or blurred vision, loss of color vision, eye pain which worsens on movement of the eye; headache, especially on waking in the morning, which may be due to high blood pressure; pain behind the ribs which spreads towards the back and worse when lying down, nausea, vomiting, fever, which may be due to inflammation of your pancreas; yellowing of the eyes or skin, pale faeces and dark urine, unexplained and persistent nausea, stomach problems, appetite loss, or unusual tiredness, which may be due to changes in your liver.

Tell your doctor if you get any of the following side effects: vertigo (head spinning); fatty faeces; sweating; palpitations (rapid heartbeat); mental confusion; appetite loss; constipation or bloating; blurred vision, eye irritation; feeling ill (malaise); tinnitus (buzzing or ringing in the ears); tingling or numbness of the hands or feet; if you have diabetes, sudden and poor blood sugar control – your doctor or pharmacist can help measure your blood sugar levels; asthma, or asthma which may be worse than usual; swelling of your hands or around your ankles/feet; mouth pain, which may show as pain or ulcers of the tongue, cheeks, lips, throat or gums; dizziness, drowsiness, feeling lethargic and tired; symptoms of low blood pressure, e.g. light-headedness; reactions to the sun such as red, painful or swollen skin. Whilst taking mefenamic acid, do not use a sun bed, sunbathe or expose your skin to artificial ultraviolet (UV) light; depression; inability to sleep; hallucinations; nervousness; ear pain.

Medicines such as Mefarex-D Tablets may be associated with a small increased risk of stroke or heart attack.

Do not take Mefarex-D Tablets:

• if you are allergic (hypersensitive) to mefenamic acid or Dicyclomine HCl.
• if you are allergic to any other NSAIDs such as aspirin, ibuprofen or celecoxib;
• if you have an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis;
• if you have a history of gastrointestinal conditions such as bleeding in the stomach, peptic ulcer, gastritis;
• if you have severe heart, liver or kidney failure;
• if you are in the last trimester of pregnancy (more than 6 months pregnant);
• if you have had heart bypass surgery

Warnings and precautions

Talk to your doctor or pharmacist before taking Mefarex-D Tablets if:

• you are taking any other NSAIDs such as ibuprofen, diclofenac; or any other anti-inflammatory medicines, including steroids such as prednisolone;
• you are taking medicines such as warfarin or clopidogrel, which are used to thin the blood;
• you are taking selective serotonin medicines such as paroxetine, which are antidepressants;
• you are elderly or have liver or kidney problems, as your doctor may monitor their function before and during treatment;
• you are trying to become pregnant
• you are previously taking painkillers such as aspirin have given you an upset stomach, or you have a history of stomach or digestive tract problems. Patients taking mefenamic acid can experience bleeding in the stomach or gut;
• you are going to have a major operation or have a bleeding disorder, as mefenamic acid can affect how your blood clots (it can make you bleed more or for longer periods of time);
• you have or have a history of asthma, as it may cause difficulties in breathing; or have epilepsy; or you have a disorder of the connective tissue, such as Systemic Lupus Erythematosus (SLE);

Medicines such as Mefarex-D Tablets may be associated with a small increased risk of stroke or heart attack. Any such risk is more associated with high doses, and prolonged treatment. Do not exceed the recommended dose or treatment duration.

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking any medicine.

Pregnancy: Mefenamic acid passes to your unborn baby. During the first six months of pregnancy, it is not known how mefenamic acid can affect your unborn baby. Your doctor or pharmacist will help you decide whether or not to take these tablets in the first six months of pregnancy. Mefarex-D Tablets should not be taken in the last three months of pregnancy, as this may prolong its duration and delay the onset of labour. This could also lead to bleeding in the mother or unborn baby.

Breast-feeding: Mefenamic acid passes into breast milk and can affect the baby. You should not breast-feed whilst taking these tablets, unless advised by your doctor.

Fertility: If you are trying to become pregnant, do not take these tablets as it may make getting pregnant more difficult. Speak to your doctor if you are trying to become pregnant or are having difficulties getting pregnant.

Driving and using machines: Mefarex-D Tablets may cause drowsiness, fatigue, dizziness or may affect your vision. If you experience any of these symptoms, you should not drive or operate machinery, or perform any tasks which may require you to be alert