Serious Skin Reactions
NSAIDs, including Merflam, can cause serious skin adverse reactions such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Inform patients about the signs and symptoms of serious skin reactions and to discontinue the use of VOLTAREN at the first appearance of skin rash or any other sign of hypersensitivity. VOLTAREN is contraindicated in patients with previous serious skin reactions to NSAIDs (see CONTRAINDICATIONS).
How Merflam works
Merflam is given to treat painful conditions such as arthritis, sprains and strains, gout, migraine, dental pain, and pain after surgical operations. It eases pain and reduces inflammation. Merflam is available on prescription.
Merflam works by blocking the effect of chemicals in your body, called cyclo-oxygenase (COX) enzymes. These enzymes help to make other chemicals in the body, called prostaglandins. Prostaglandins are produced at sites of injury or damage, and cause pain and inflammation. By blocking the effect of COX enzymes, fewer prostaglandins are produced, which means pain and inflammation are eased.
There are two forms of Merflam - Merflam sodium and Merflam potassium. The main difference between the two is that Merflam potassium is absorbed into the body more quickly than Merflam sodium. A quick action is useful where immediate pain relief is required, and a prolonged action is more useful in reducing inflammation. Some brands of Merflam also contain a medicine called misoprostol. The brands are called Arthrotec® and Misofen®, and are prescribed for arthritis. Misoprostol helps to protect the stomach against irritation which can be caused by taking Merflam over a period of time.
Merflam is not a suitable medicine for people who have heart disease (such as heart failure), or who have circulatory problems, or who have had a heart attack or a stroke. This is because it has been found that there is a small increased risk of heart attack and stroke in this group of people. Other anti-inflammatory medicines are more suitable for people with these conditions - ask your doctor or pharmacist for advice about an alternative medicine.
Merflam is also formulated as skin gels, patches and as eye drops. There is more information about these formulations in the separate medicine leaflets called Merflam gel/patch for pain and inflammation, Merflam gel for sun damage and Merflam eye drops.
Rated Merflam for Pain Report
I have had Golfers Elbow for 2 years and it does not seem to be healing. If I take a 50mg Merflam at bed time, the next morning the pain is gone for the day and I can play golf pain free. It also seems to help keeping the once weekly golf from making it worse.
2. Key facts
- Take Merflam tablets or capsules with a meal or snack, or just after eating.
- It's best to take the lowest dose of Merflam for the shortest time to control your symptoms.
- The most common side effects are headaches, dizziness, stomach pain, feeling or being sick, diarrhoea and rashes.
- Merflam tablets come as either Merflam potassium or Merflam sodium. They work as well as each other.
- Merflam is also called by the brand names Voltarol, Dicloflex, Econac and Fenactol.
How should I take Merflam?
Different brands of Merflam contain different amounts of this medicine, and may have different uses. If you switch brands, your dose needs may change. Follow your doctor's instructions about how much medicine to take. Ask your pharmacist if you have any questions about the brand you receive at the pharmacy.
Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger amounts or for longer than recommended. Use the lowest dose that is effective in treating your condition.
Take Zorvolex on an empty stomach, at least 1 hour before or 2 hours after a meal.
Do not crush, chew, or break an extended-release tablet or delayed-release tablet. Swallow it whole.
Dissolve Cambia powder in to 2 ounces of water. Do not use any other type of liquid. Stir this mixture and drink all of it right away. Cambia works best if you take it on an empty stomach.
Call your doctor if your headache does not completely go away after taking Cambia. Do not take a second dose of Merflam powder without your doctor's advice. Overuse of migraine headache medicine can make headaches worse. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks.
If you use Merflam long-term, you may need frequent medical tests.
Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as Merflam may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time. Do not take an NSAID such as Merflam if you have recently had a heart attack, unless directed to do so by your doctor. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke, if you smoke, and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech.
If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not take Merflam right before or right after the surgery.
NSAIDs such as Merflam may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or drink large amounts of alcohol while taking Merflam. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin; other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). Also tell your doctor if you have or have ever had ulcers, bleeding in your stomach or intestines, or other bleeding disorders. If you experience any of the following symptoms, stop taking Merflam and call your doctor: stomach pain, heartburn, vomiting a substance that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.
Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably order certain tests to check your body's response to Merflam. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with Merflam and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) to obtain the Medication Guide.
Merflam interacts with many different drugs. It’s always important to tell your doctor and pharmacist about all of the treatments you are taking.
This includes not only all of your prescription and over-the-counter medicines, but also products that may not seem like medication, such as: vitamins and other dietary supplements (nutritional shakes, protein powders, etc.), and herbals along with any legal or illegal recreational drugs.
You should not take Merflam if you are taking the following drugs:
- Apixaban (Eliquis)
- Elvitegravir/cobicistat/emtricitabine/tenofovir (Stirbild)
- Ketorolac nasal spray (Sprix)
- Methotrexate (Trexall)
- Premetrexed (Alimta)
- Pirfinidone (Esbriet)
If you are taking any of the following, talk to your doctor about drug options other than Merflam:
- Blood thinners, such as fondaparinux (Arixtra), dabigatran (Pradaxa) warfarin (Jantoven, Coumadin) or heparin
- Antidepressants, such as citalopram (Celexa), paroxetine (Paxil), or escitalopram (Lexapro)
- Water pills, such as hydrochlorothiazide (Esidrix, Microzide), chorthalidone (Thalitone), or chlorothiazide (Diuril)
- Beta blockers, such as acebutolol (Sectral), bisoprolol ( Zebeta), atenolol (Tenormin), esmolol (Brevibloc), or carvedilol (Coreg)
- Other NSAIDS, including: celecoxib (Celebrex), naproxen (Aleve, Naprosyn), meloxicam (Mobic), nabumetone (Relafen), or etodolac (Lodine)
- Diabetes medications called sulfonylureas, such as glimepiride (Amaryl), glyburide (DiaBeta, Micronase, Glynase), and glipizide (Glucotrol)
3. Who can take and can't take Merflam
Most adults can take Merflam.
Children may be prescribed Merflam to treat joint problems. Merflam tablets, capsules and suppositories are suitable for children aged 1 year and above.
Merflam isn't suitable for certain people.
Tell your doctor or pharmacist if you have:
- had an allergic reaction to Merflam or any other medicines in the past
- an allergy to aspirin or other non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen or naproxen
- ever had signs of asthma (wheezing), a runny nose, swelling of the skin (angioedema) or a rash after taking NSAIDs
- ever had stomach ulcers, bleeding in the stomach or intestines, or a hole in your stomach
- high blood pressure (hypertension)
- heart failure, or severe liver disease or kidney disease
- Crohn's disease or ulcerative colitis
- a blood clotting disorder
Tell your doctor or pharmacist if you're pregnant, planning to become pregnant, or breastfeeding.
Important: if you experience any of the following less common but more serious symptoms, stop taking Merflam and contact your doctor for advice straightaway:
- If you have any breathing difficulties such as wheeze or breathlessness.
- If you have any signs of an allergic reaction such as swelling around your mouth or face, or a severe itchy skin rash.
- If you pass blood or black stools, bring up (vomit) blood, or have severe tummy (abdominal) pains.
If you experience any other symptoms which you think may be due to Merflam, speak with your doctor or pharmacist for further advice.
Serious Side Effects
Stop taking Merflam and get immediate medical attention if you experience any of the following:
- Liver damage or inflammation of the liver (watch for yellowing or graying of the skin or eyes, swelling of the abdomen or lower extremities)
- Low blood pressure (one sign of low blood pressure is dizziness when getting up to stand)
- Blood disorders, such as low platelet count, decreased hemoglobin, and decreased bone marrow activity
- Congestive heart failure (watch for swelling in your lower limbs, shortness of breath, trouble walking normal distances’, extra tiredness)
- Severe and potentially life-threatening skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis (tell your doctor about any skin abnormalities; get emergency medical help right away if you have any dramatic or severe skin reactions)
Rated Merflam for Ankylosing Spondylitis Report
Started 4 months ago for sacrolitis. After less than week of taking 3 x a day, reduced my low back pain from 8 to a 2. Now i take 1 x a day and seems to keep the pain at bay. No side effects for me in the begining or now.
Rated Merflam for Osteoarthritis Report
I had my hip replaced 2 years ago. My hip was dead before so I have nothing bad to say about having my hip replaced other than the fact that I had a mild pain all the time and then is severe pain every once in awhile. The effects of the pain made me make choices of things I would do and wouldn't do. This drug it's a lifesaver it is made my life normal again like it was before I had my hip replaced with physical therapy in this drug I believe I will get back to normal again I did not believe that before.
The apparent volume of distribution (V/F) of Merflam sodium is 1.4 L/kg.
Merflam is more than 99% bound to human serum proteins, primarily to albumin. Serum protein binding is constant over the concentration range (0.15-105 mcg/mL) achieved with recommended doses.
Merflam diffuses into and out of the synovial fluid. Diffusion into the joint occurs when plasma levels are higher than those in the synovial fluid, after which the process reverses and synovial fluid levels are higher than plasma levels. It is not known whether diffusion into the joint plays a role in the effectiveness of Merflam.
Missed Dose of Merflam
If you miss a dose of Merflam, try to take it as soon as you remember, unless it is almost time for the next dose. In that case, skip the missed dose and take your next dose at the regular time.
Do not take two doses of the medication at the same time.