Safety of Meftal Spas (Mefenamic Acid) in Dengue Fever
Meftal Spas (mefenamic acid) should NOT be used in patients with dengue fever due to increased risk of bleeding complications.
Rationale for Avoiding NSAIDs in Dengue
Dengue fever is characterized by thrombocytopenia (low platelet count) which increases bleeding risk. Multiple guidelines specifically contraindicate NSAIDs like mefenamic acid in dengue management:
The World Health Organization and US Centers for Disease Control recommend acetaminophen/paracetamol for pain and fever management in dengue while specifically contraindicating NSAIDs due to potential bleeding risk 1.
Praxis Medical Insights clearly states: "Avoid NSAIDs, as they may worsen bleeding risk, and use acetaminophen/paracetamol instead for fever control" with a high strength of evidence level 2.
Bleeding Risk in Dengue
Dengue patients are at significant risk for bleeding complications:
A study of 638 dengue patients found a 24.1% prevalence of bleeding tendencies, with prior anti-platelet drug intake significantly increasing bleeding risk 3.
Thrombocytopenia, leukopenia, and raised hematocrit levels are the most significant hematological parameters when assessing dengue severity 4.
Patients with severe dengue commonly experience mucosal bleeding (71.4%), fluid accumulation (57.1%), shock (35.7%), and gastrointestinal bleeding (28.6%) 4.
Mechanism of Increased Risk
Mefenamic acid (Meftal Spas) is an NSAID that inhibits platelet aggregation through its effect on cyclooxygenase enzymes. This anti-platelet effect compounds the already compromised hemostatic function in dengue patients who typically have:
- Thrombocytopenia (platelet counts often <70,000/mm³)
- Coagulation abnormalities (elevated INR >2.0 and PTT >60 seconds) 3
- Potential endothelial damage from the virus
Alternative Management Options
For Pain and Fever Control:
- First-line: Acetaminophen/paracetamol is the recommended analgesic and antipyretic 2, 1
- Dosing: Standard dosing based on age and weight, not exceeding maximum daily limits
For Fluid Management:
- Fluid resuscitation is critical in dengue management:
Special Considerations
Monitoring Requirements:
- Daily complete blood count to track hemoglobin/hematocrit trends and platelet count 2
- Regular monitoring of vital signs and clinical assessment for warning signs 2
- Assessment for bleeding manifestations
Warning Signs Requiring Urgent Attention:
- Abdominal pain
- Persistent vomiting
- Clinical fluid accumulation
- Mucosal bleeding
- Lethargy
- Liver enlargement >2 cm 2
Emerging Research
While some recent research suggests that low-dose ibuprofen might be comparable to acetaminophen in non-severe dengue 6, this evidence is preliminary and contradicts established guidelines. A systematic review found no evidence supporting any interventions for preventing or treating clinically significant bleeding in dengue 7.
Conclusion
Until stronger evidence emerges, the safest approach is to avoid Meftal Spas (mefenamic acid) in dengue patients and use acetaminophen/paracetamol instead for symptom management. The risk of bleeding complications outweighs any potential benefits of NSAIDs in this population.