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Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascularCVthrombotic eventsincluding myocardial infarctionMIand strokewhich can be fatalBased on available datait is unclear that the risk for CV thrombotic events is similar for all NSAIDsThe relative increase in serious CV thrombotic events over baseline conferred by NSAID use appears to be similar in those with and without known CV disease or risk factors for CV diseaseHoweverpatients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic eventsdue to their increased baseline rateSome observational studies found that this increased risk of serious CV thrombotic events began as early as the first weeks of treatmentThe increase in CV thrombotic risk has been observed most consistently at higher doses.

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Signs of an allergic reactionlike rashhivesitchingredswollenblisteredor peeling skin with or without feverwheezingtightness in the chest or throattrouble breathingswallowingor talkingunusual hoarsenessor swelling of the mouthfacelipstongueor throatSigns of bleeding like throwing up blood or throw up that looks like coffee groundscoughing up bloodblood in the urineblackredor tarry stoolsbleeding from the gumsvaginal bleeding that is not normalbruises without a reason or that get biggeror any bleeding that is very bad or that you cannot stopSigns of kidney problems like unable to pass urinechange in how much urine is passedblood in the urineor a big weight gainSigns of high potassium levels like a heartbeat that does not feel normalfeeling confusedfeeling weaklightheadedor dizzyfeeling like passing outnumbness or tinglingor shortness of breathSigns of high blood pressure like very bad headache or dizzinesspassing outor change in eyesightShortness of breatha big weight gainor swelling in the arms or legsChest pain or pressure or a fast heartbeatWeakness on 1 side of the bodytrouble speaking or thinkingchange in balancedrooping on one side of the faceor blurred eyesightFeeling very tired or weakRinging in earsMood changesLow mooddepressionVery bad belly painVery bad back painA very bad skin reactionStevens-Johnson syndrome/toxic epidermal necrolysismay happenIt can cause very bad health problems that may not go awayand sometimes deathGet medical help right away if you have signs like redswollenblisteredor peeling skinwith or without feverred or irritated eyesor sores in your mouththroatnoseor eyes.

Mefenamic acid pharmacokinetics have not been studied in patients with hepatic dysfunctionAs hepatic metabolism is a significant pathway of mefenamic acid eliminationpatients with acute and chronic hepatic disease may require reduced doses of Ponstel compared to patients with normal hepatic functionsee WARNINGSHepatotoxicity

NSAIDsincluding Ponstelcan lead to new onset of hypertension or worsening of pre-existing hypertensioneither of which may contribute to the increased incidence of CV eventsPatients taking angiotensin converting enzymeACEinhibitorsthiazides diureticsor loop diuretics may have impaired response to these therapies when taking NSAIDssee PRECAUTIONSDrug Interactions

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