On November 30, 2023, the Indian Pharmacopoeia Commission (IPC) published a drug safety alert stating that consumers and healthcare professionals should closely monitor the possibility of adverse drug reactions associated with the painkiller Meftal. Meftal, which constitutes mefenamic acid, is commonly used for menstrual cramps and rheumatoid arthritis.
Meftal is a painkiller that is prescribed for the treatment of rheumatoid arthritis, dysmenorrhea, osteoarthritis, mild-to-moderate pain, inflammation, fever, and dental pain.
The Indian Pharmacopoeia Commission, in its alert, issued 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.
According to the alert issued by IPC, "Healthcare professionals, patients/consumers are advised to closely monitor the possibility of the above adverse drug reaction (ADR) associated with the use of the suspected drug."
It also said that if such a reaction is encountered, the alert advises that people should report the matter to the national coordination center of the PvPI under the commission by filing a form on the website www.ipc.gov.in or through the Android mobile app ADR PvPI and PvPI Helpline No. 1800-180-3024.
The Indian Pharmacopoeia Commission (IPC) is an autonomous institution of the Ministry of Health and Family Welfare, Government of India. The IPC lays down standards for all drugs that are manufactured, sold, and consumed in India.
On this IPC alert, Dr. Tanaya has shared her opinion on her Instagram post from her Instagram account, stating, “No matter what medicine you take, it will always have effects and side effects. And one of the rare side effects of mefenamic acid is called DRESS syndrome. There has not been a single case of mefenamic acid-related DRESS syndrome in India so far. However, this is not brand new news; we know certain NSAIDs can cause DRESS syndrome. This is just the government reminding us not to pop this pill, as it is done under the consultation of a doctor.
What are your key takeaways from this?
If you have been having Meftal and it hasn’t created any allergic reactions in your body, it’s probably okay for you as long as you are doing it under the supervision of a doctor.
It's still okay to take painkillers for period pain, and it’s not something that you need to be afraid of as long as you do it under the consultation of a doctor.
This is just an overblown media controversy, and you need to relax and chill.”
What is DRESS syndrome all about?
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a distinct, severe, idiosyncratic reaction to a drug characterized by an extended latency period. It is followed by a variety of clinical manifestations like fever, rash, lymphadenopathy, eosinophilia, and a wide range of mild-to-severe systemic presentations.1
DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is an adverse reaction term that is presently used to describe a hypersensitivity reaction with an estimated mortality of up to 10%. Rapid clinical recognition and discontinuation of suspected medicines help to decrease morbidity and mortality related to this syndrome. DRESS syndrome is a delayed-type IVb hypersensitivity reaction thought to be intermediate by antiviral T cells. 2
DRESS syndrome most commonly manifests 2–8 weeks after starting the offending medicine, with a mean onset of three weeks. Upon re-challenge with the offending medicine, symptoms may reappear within a day. Treatment of DRESS involves early recognition, followed by immediate stoppage of all suspected medicines. 2
References:
1. Sonal Choudhary (MD), Michael McLeod (MS), Daniele Torchia (MD), and Paolo Romanelli (MD), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome, J Clin Aesthet Dermatol. 2013 Jun; 6(6): 31–37. [Cited on 8/12/2023]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718748/#:~:text=Drug%20rash%20with%20eosinophilia%20and%20systemic%20symptoms%20(DRESS)%20syndrome%20is,by%20a%20prolonged%20latency%20period.
2. DRESS syndrome: remember to look under the skin, June 2011, 32(2): 12–13 [Cited on 8/12/2023] https://www.medsafe.govt.nz/profs/puarticles/dresssyndromejune2011.htm#:~:text=DRESS%20syndrome%20(Drug%20Rash%20with,mortality%20of%20up%20to%2010%25.
(Input from various media sources)
(Rehash/Komal Bhoi)