Tolfenamic acid

How it works

It inhibits cyclo-oxygenase enzymes, reducing the synthesis of prostaglandins that mediate pain and inflammation.

Prescribing in practice

• Like other NSAIDs it carries risks of gastrointestinal ulceration and bleeding, cardiovascular and renal adverse effects, so it should be used at the lowest effective dose for the shortest time and avoided in those with relevant contraindications.
• It should be used with caution in patients with a history of peptic ulcer disease, heart failure, hypertension or renal impairment.
• Dysuria and other urinary symptoms have been reported with this agent and usually resolve on stopping.

Monitoring

Monitor for gastrointestinal, renal and cardiovascular adverse effects, particularly with prolonged or recurrent use or in at-risk patients.

Counselling the patient

• A pain-relieving tablet used to treat migraine attacks.
• Take with or after food and report indigestion, black stools or vomiting blood.
• Avoid combining with other NSAIDs and seek advice if migraines worsen or change.

Evidence & guidelines

Tolfenamic acid is licensed for acute migraine, with its NSAID class effects and gastrointestinal and cardiovascular precautions reflected in MHRA guidance and the SPC.