Each tablet of Feminax Ultra contains 250mg of Naproxen as an active ingredient. The licensed use of Feminax Ultra is in the treatment of primary dysmenorrhea. Naproxen is recommended as one of the first-line drugs in the management of acute gout attack. Is it possible to use of Feminax Ultra for gout?
Feminax Ultra indicated use, legal status & dose recommendations
Feminax Ultra is indicated in the treatment of primary dysmenorrhoea of women aged 15 to 50 years. Primary dysmenorrhoea (period pains) is associated with pain and cramps before or during menstruation.
Feminax Ultra is a pharmacy only medicine (P). A box of 9 tablets can only be purchased from registered pharmacies operating under the supervision of a pharmacist. Feminax Ultra can also be purchased from registered online pharmacies.
The dose recommendation of Feminax Ultra in the treatment of a primary dysmenorrhoea:
- Day 1: two tablets (500mg) in the first instance and then 1 tablet (250mg) after 6 to 8 hours if still needed.
- Day 2 and 3: One tablet (250mg) every 6 to 8 hours if needed.
- No more than three tablets of Feminax Ultra should be taken in one day.
- The maximum licensed duration of treatment with Feminax Ultra is three days per each period.
Gout: the management of acute attack
Naproxen (the active ingredient of Feminax Ultra) is recognised as one of the first drugs in the management of acute gout attack. Other NSAIDs can also be used. Providing there are no contraindications (for example a history of gastrointestinal bleeding related to NSAIDS use) the following recommended dose of Naproxen is used in acute gout attack:
- Initially, 750 mg (3 x 250mg tablets), then 250 mg (1 tablet) every 8 hours until the attack has passed.
- NICE recommends continuing the treatment to 1-2 days after the attack is resolved (NICE, 2018)
Why is Naproxen used in the management of gout and primary dysmenorrhoea?
Naproxen belongs to a group of drugs called Nonsteroidal anti-inflammatory drugs (NSAIDs). This class of drugs reduces pain and inflammation. One of the factors contributing to symptoms of primary dysmenorrhoea is the increased production of prostaglandins in the body (AAFP, 1999). NSAIDs, such as naproxen, stop the production of prostaglandins, which is a primary mechanism of action of this class of the group.
Similarly, prostaglandins are produced during the acute gout attack and contribute to the presenting symptoms, hence the rationale behind the NSAIDs therapy (Cronstein & Sunkureddi, 2013).
Feminax Ultra for gout
In theory, Feminax Ultra could be used for the management of gout; however, this product is not licensed for this indication. Each pharmacy operates according to set standard operating procedures (SOPs). Patients who request medication from a pharmacy are usually asked a set of questions to assess the need for the product. Common questions which are asked include:
- Who is the medication for?
- What are the symptoms?
- How long have the symptoms been present?
- Do you take any medication?
The sale of Feminax Ultra for gout would be refused based on the product license.
A patient who is experiencing a gout attack needs to see their GP to get an appropriate diagnosis and assessment. Patients who are prescribed NSAIDs for treatment of acute gout may also be prescribed a Proton Pump Inhibitor (PPI), such as Omeprazole or another PPI, to protect the stomach from the irritation caused by NSAIDs.
Patient with re-current gout attacks (two or more attacks of gout in 12 months) need a GP review, so that urate-lowering therapy may be considered as preventative therapy (NICE, 2018).
AAFP (1999). Primary dysmenorrhea. Available at: https://www.aafp.org/afp/1999/0801/p489.html Accessed on 08/12/2019
Cronstein Bruce, Sunkureddi Prashanth (2013). Mechanistic Aspects of Inflammation and Clinical Management of Inflammation in Acute Gouty Arthritis. Available at: https://dx.doi.org/10.1097%2FRHU.0b013e31827d8790 Accessed on 08/12/2019
NICE (2018). Gout. Scenario: Preventing gout. Available at: https://cks.nice.org.uk/gout#!scenario:1 Accessed on 08/12/2019