Can a Patient with Stomach Ache Take Ponstan (Mefenamic Acid)?
No, Ponstan (mefenamic acid) should not be taken for stomach ache, as NSAIDs including mefenamic acid can cause or worsen gastrointestinal symptoms and are contraindicated when abdominal pain is present without a clear non-GI diagnosis.
Why Ponstan Is Problematic for Stomach Ache
Gastrointestinal Toxicity Profile
- Mefenamic acid causes significant gastrointestinal complications including gastritis, duodenitis, and bleeding ulcers, even at therapeutic doses 1
- The drug can induce severe enteropathy with villous atrophy, particularly with prolonged use (>3 months), presenting as chronic diarrhea and weight loss 2
- Unlike other NSAIDs, mefenamic acid specifically damages intestinal villi and causes malabsorption with steatorrhea 3
Clinical Reasoning
The fundamental issue is that stomach ache is a symptom, not a diagnosis. Without knowing the underlying cause, administering an NSAID like Ponstan could:
- Mask serious pathology requiring urgent evaluation (appendicitis, pancreatitis, bowel obstruction)
- Worsen existing GI inflammation if the pain stems from gastritis, peptic ulcer disease, or inflammatory bowel conditions
- Create new GI injury through direct mucosal damage and prostaglandin inhibition
Appropriate Management Algorithm for Stomach Ache
First-Line Approach
For non-specific abdominal pain without alarm features:
- Consider antispasmodics (hyoscine, dicyclomine) for cramping pain, particularly if meal-related 4
- Proton pump inhibitors or H2-receptor antagonists for suspected gastritis or reflux 4, 5
- Dietary modifications and hydration as supportive measures 6
Second-Line Options for Persistent Pain
If pain persists beyond simple measures:
- Low-dose tricyclic antidepressants (amitriptyline 10 mg daily, titrated to 30-50 mg) for visceral pain modulation 4
- These work as gut-brain neuromodulators and are more appropriate than NSAIDs for functional abdominal pain 4
When to Escalate
Red flags requiring immediate evaluation before any analgesic:
- Severe or worsening pain
- Associated fever, vomiting, or changes in bowel habits
- History of peptic ulcer disease or GI bleeding
- Recent medication changes (antibiotics, GLP-1 agonists) 6, 7
Critical Pitfalls to Avoid
The NSAID Trap
Many patients and providers reflexively reach for NSAIDs for any pain, but abdominal pain is the one scenario where NSAIDs are particularly dangerous. The gastrointestinal tract is both the site of pathology and the target organ for NSAID toxicity 1.
Delayed Diagnosis Risk
Using Ponstan for stomach ache may temporarily reduce pain through anti-inflammatory effects, creating false reassurance while serious pathology progresses. This is especially concerning for conditions like early appendicitis or mesenteric ischemia.
Cumulative Toxicity
Even if a single dose seems tolerable, mefenamic acid's enteropathy can develop insidiously with regular use, presenting weeks to months later with severe malabsorption 2.
Alternative Pain Management
If analgesia is absolutely necessary while determining the cause:
- Acetaminophen (paracetamol) is safer for undifferentiated abdominal pain, though still not ideal
- Antispasmodics provide targeted relief for cramping without mucosal injury 4
- For confirmed diagnoses like dysmenorrhea (where Ponstan is actually indicated), the risk-benefit calculation changes entirely
The key principle: diagnose first, then treat appropriately based on the underlying cause rather than empirically suppressing symptoms with potentially harmful medications.