Mervan SR200 mg

Mervan SR is a non-steroidal anti-inflammatory drug (NSAID) used for the relief of pain and inflammation associated with the following established indications:

• Osteoarthritis — for relief of joint pain and stiffness.
• Rheumatoid arthritis — for relief of joint pain, swelling, and inflammation.
• Ankylosing spondylitis — for relief of spinal and joint pain and inflammation.
• Acute musculoskeletal pain, including low back pain (lumbago), periarthritis, sprains, and post-traumatic pain and swelling.
• Postoperative and dental pain (e.g. toothache), as short-term symptomatic relief.

Mervan SR provides symptomatic relief of pain and inflammation; it does not alter the underlying course of the disease. It should be used at the lowest effective dose for the shortest duration consistent with the patient's treatment goals.

Each tablet contains Aceclofenac as the active pharmaceutical ingredient, commonly available as:

• Aceclofenac 100 mg conventional (immediate-release) tablet, usually taken twice daily.
• Aceclofenac 200 mg sustained-release (SR)/extended-release (CR) tablet, taken once daily.

Tablets also contain standard pharmaceutical excipients (binders, fillers, coating agents) that do not have independent therapeutic activity.

Mervan SR is a phenylacetic acid derivative NSAID, structurally related to diclofenac. It is used to relieve pain, swelling, and stiffness caused by inflammatory and degenerative joint and musculoskeletal conditions. Mervan SR is rapidly and almost completely absorbed after oral administration and is extensively metabolized in the liver, partly to 4'-hydroxyMervan SR and to diclofenac.

Mervan SR is available in Bangladesh as conventional tablets (100 mg) and sustained/extended-release tablets (200 mg), marketed under various brand names.

Mervan SR belongs to the class of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), specifically the phenylacetic acid derivative subgroup (chemically related to diclofenac). It is classified as a non-selective cyclooxygenase (COX) inhibitor with analgesic, anti-inflammatory, and antipyretic properties.

Aceclofenac exerts its therapeutic effect by inhibiting the cyclooxygenase (COX-1 and COX-2) enzymes, which reduces the synthesis of prostaglandins — key mediators of pain, inflammation, and fever. Some data suggest Aceclofenac preferentially inhibits COX-2 over COX-1 relative to some other NSAIDs, and it may also modestly reduce interleukin-1 and inhibit synthesis of some cytokines involved in cartilage matrix degradation, though the clinical significance of this is not established.

Pharmacokinetics: Aceclofenac is rapidly and almost completely absorbed from the gastrointestinal tract after oral dosing, with peak plasma concentrations reached in 1.25–3 hours. It is highly protein bound (>99%) and undergoes extensive hepatic metabolism, primarily via CYP2C9, to 4'-hydroxyaceclofenac and other metabolites, including small amounts of diclofenac. The elimination half-life is approximately 4 hours, and it is excreted mainly in the urine as metabolites.

Mervan SR tablets should be taken orally, swallowed whole with a glass of water, preferably with or immediately after meals to minimize gastrointestinal discomfort. Sustained-release/extended-release tablets should not be crushed, split, or chewed, as this may alter the release profile of the drug.

Mervan SR has the following well-recognized, clinically significant drug interactions:

• Anticoagulants (e.g. warfarin): Increased risk of bleeding; concurrent use requires close monitoring of coagulation status.
• Lithium: Mervan SR can reduce renal clearance of lithium, increasing plasma lithium levels and risk of toxicity.
• Digoxin: Mervan SR may increase plasma digoxin concentrations; monitoring of digoxin levels is advised.
• Diuretics and antihypertensives (e.g. ACE inhibitors, ARBs): Mervan SR may reduce the antihypertensive/diuretic effect and increase the risk of renal impairment, particularly in volume-depleted patients ("triple whammy" effect with ACE inhibitor/ARB plus diuretic).
• Methotrexate: NSAIDs including Mervan SR can reduce renal clearance of methotrexate, increasing its toxicity, especially at high methotrexate doses.
• Other NSAIDs or corticosteroids: Concurrent use increases the risk of gastrointestinal ulceration and bleeding.
• Oral hypoglycemic agents: Mervan SR may potentiate the effect of sulfonylureas; blood glucose monitoring is advised.
• Cyclosporine: Increased risk of nephrotoxicity when used together.

Most side effects of Mervan SR are mild and reversible on discontinuation. Commonly reported effects include:

• Gastrointestinal: Dyspepsia, abdominal pain, nausea, diarrhea; less commonly, peptic ulcer, gastrointestinal bleeding, or perforation (class effect of NSAIDs; see Precautions).
• Nervous system: Headache, dizziness, vertigo, drowsiness.
• Skin: Rash, pruritus, urticaria.
• Other (less common): Elevated liver enzymes, edema, elevated blood pressure, and, rarely, renal impairment.

Serious but rare reactions include severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), severe hepatotoxicity, and cardiovascular thrombotic events (myocardial infarction, stroke) as seen with NSAIDs as a class. Patients should seek prompt medical attention for signs of GI bleeding (black stools, vomiting blood), unexplained rash, jaundice, or chest pain/shortness of breath.

Mervan SR should be avoided during pregnancy, particularly in the third trimester, when NSAIDs are contraindicated due to the risk of premature closure of the fetal ductus arteriosus, oligohydramnios, and potential fetal renal impairment. In early pregnancy, Mervan SR should be used only if clearly needed, at the lowest effective dose for the shortest duration, and only after the potential benefit to the mother has been weighed against potential risk to the fetus; consult a physician before use.

It is not established whether Mervan SR is excreted in human breast milk. Because of the potential for adverse effects on the nursing infant, Mervan SR should be avoided during breastfeeding unless a physician determines the benefit outweighs the risk.

Cardiovascular risk: Like other NSAIDs, Mervan SR may be associated with an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may increase with duration of use and in patients with pre-existing cardiovascular disease or risk factors; use the lowest effective dose for the shortest duration.

Gastrointestinal risk: NSAIDs including Mervan SR carry a risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can occur at any time and without warning symptoms. Elderly patients and those with a history of peptic ulcer disease are at greater risk.

Renal effects: Use with caution in patients with renal impairment, heart failure, hepatic impairment, or in volume-depleted patients (e.g. from diuretic use), as NSAIDs can reduce renal blood flow and precipitate acute kidney injury.

Hepatic effects: Rare cases of hepatotoxicity (elevated liver enzymes, hepatitis) have been reported; discontinue if signs of liver dysfunction develop.

Fluid retention and hypertension: Mervan SR can cause fluid retention and edema and may worsen hypertension or heart failure control.

Hematologic effects: May inhibit platelet aggregation; use with caution in patients with bleeding disorders or those on anticoagulant therapy.

Skin reactions: Serious skin reactions, some fatal, can occur without warning; discontinue at first appearance of skin rash or hypersensitivity signs.

Driving/machinery: Patients experiencing dizziness or drowsiness should avoid driving or operating machinery.

Mervan SR should be used with caution in elderly patients, who are more susceptible to adverse effects (see Use in Special Populations).

Symptoms of Mervan SR overdose may include nausea, vomiting, abdominal pain, gastrointestinal bleeding, drowsiness, dizziness, and, in severe cases, hypotension, respiratory depression, or renal impairment. There is no specific antidote for Mervan SR overdose.

In case of suspected overdose, seek immediate medical attention or contact a poison control center/emergency services right away. Treatment is supportive and symptomatic; management may include gastric decontamination if performed soon after ingestion and supportive care per treating physician's judgment. Do not attempt to manage an overdose at home.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

Pregnant Women

Mervan SR should be avoided during pregnancy, especially in the third trimester (see Pregnancy and Lactation).

Breastfeeding Mothers

Mervan SR should be avoided during breastfeeding unless clearly necessary (see Pregnancy and Lactation).

Pediatric Patients

Safety and efficacy of Mervan SR have not been established in children; it is generally not recommended for use in this population.

Elderly Patients

Elderly patients are at increased risk of NSAID-related gastrointestinal, renal, and cardiovascular adverse effects. Mervan SR should be used at the lowest effective dose for the shortest duration necessary, with monitoring for adverse effects.

Renal Impairment

Use with caution in mild renal impairment; avoid in severe renal impairment.

Hepatic Impairment

Use with caution and at reduced dose in mild-to-moderate hepatic impairment; avoid in severe hepatic impairment.

Mervan SR should be used at the lowest effective dose for the shortest duration consistent with individual treatment goals, as determined by the prescribing physician. For acute musculoskeletal pain, short courses of a few days to two weeks are typical, while chronic conditions such as osteoarthritis or rheumatoid arthritis may require longer-term use under regular medical review to monitor for adverse effects.

Non-Steroidal Anti-Inflammatory Drug (NSAID) – Phenylacetic acid derivative

Aceclofenac inhibits cyclooxygenase (COX-1 and COX-2) enzymes, blocking the conversion of arachidonic acid to prostaglandins, thromboxanes, and other prostanoids. By reducing prostaglandin synthesis at sites of tissue injury and inflammation, Aceclofenac decreases pain, swelling, and inflammation. It may also modestly suppress the production of certain cytokines (e.g. interleukin-1) implicated in cartilage degradation, contributing to its anti-inflammatory action in joint disease.

The safety and efficacy of Mervan SR have not been established in pediatric patients. Mervan SR is generally not recommended for use in children and adolescents under 18 years of age, and specifically is not recommended in children under 6 years of age per manufacturer labeling, due to lack of adequate safety and efficacy data in this population. Alternative, better-studied analgesic/anti-inflammatory options should be considered for pediatric patients, under physician guidance.