How does it work?
Emflex capsules contain the active ingredient acemetacin, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID).
NSAIDs are used to relieve pain and inflammation.
Acemetacin works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins.
Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Acemetacin blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Acemetacin is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, back pain and pain following orthopaedic procedures or other surgery.
The capsules should preferably be taken with food to help avoid irritating the stomach.
What is it used for?
- Reducing pain and inflammation in conditions such as rheumatoid arthritis and osteoarthritis.
- Lower back pain.
- Reducing pain and inflammation following surgery.
- This medicine should be taken with or after food.
- This medicine may mask the signs and symptoms of infection, such as fever and inflammation. This may make you think mistakenly that an infection is getting better when it isn't, or that an infection is less serious than it is. For this reason you should tell your doctor if you get an infection while you are taking this medicine.
- Your doctor will prescribe you the lowest effective dose of this medicine for the shortest possible time necessary to relieve your symptoms. This is to minimise the chances of any side effects, particularly those mentioned below. It is important not to exceed the prescribed dose.
- NSAIDs can occasionally cause serious side effects on the gut, such as ulceration, bleeding or perforation of the stomach or intestinal lining. This type of side effect is more likely to occur in elderly people and in people taking high doses of the medicine. The risk can also be increased by taking certain other medicines (see below). It is important that these people, as well as people with a history of disorders affecting the stomach or intestines, are closely monitored by a doctor while taking this medicine. If your doctor thinks you are at high risk of side effects on the gut you may be prescribed an additional medicine to help protect your gut. All people taking this medicine should stop treatment and consult their doctor immediately if they experience any sign of bleeding from the stomach or intestine during treatment, for example vomiting blood and/or passing black/tarry/bloodstained stools.
- Non-steroidal anti-inflammatory drugs such as this one may be associated with a small increase in the risk of experiencing a heart attack or stroke, although acemetacin may have a lower risk than some other NSAIDs. Any risk is more likely with high doses and prolonged treatment. If you have heart problems, have ever had a stroke, or think that you might be at risk of these conditions (for example if you have high blood pressure, diabetes, high cholesterol or are a smoker) you should discuss your treatment with your doctor or pharmacist.
- Very rarely, NSAIDS may cause serious blistering or peeling skin reactions (eg Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis). For this reason, you should stop taking this medicine and consult your doctor if you get a skin rash or sores inside your mouth while taking this medicine. This side effect is very rare, but if it occurs, is most likely to happen in the first month of treatment.
- If you have cirrhosis of the liver, heart failure or kidney disease, you are on a low sodium diet, or you are taking diuretic medicines, your kidney function should be assessed before starting and regularly throughout treatment with this medicine.
- During long-term treatment with this medicine you should have regular check-ups with your doctor so that you can be monitored for possible side effects of the medicine. This might include routine blood tests to monitor your kidney function, liver function and levels of blood components, particularly if you are elderly.
Use with caution in
- Elderly people.
- History of disorders affecting the stomach or intestines.
- Inflammatory bowel disease such as Crohn's disease or ulcerative colitis.
- Kidney disease.
- Liver disease.
- Heart failure.
- High blood pressure (hypertension).
- Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease), eg angina or history of heart attack.
- Disease of the blood vessels in and around the brain (cerebrovascular disease), eg history of stroke or mini-stroke (TIA).
- Poor circulation in the arteries of the legs or feet (peripheral arterial disease).
- Raised levels of fats such as cholesterol in the blood (hyperlipidaemia).
- Imbalance of water and salt concentrations in the blood (fluid and electrolyte imbalance).
- People with blood clotting problems or taking anticoagulant medicines.
- History of asthma.
- History of allergies.
- Parkinson's disease.
- Psychiatric disorders.
- Diseases affecting connective tissue, eg systemic lupus erythematosus.
Not to be used in
- People in whom aspirin or other NSAIDs, eg diclofenac, cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal inflammation (rhinitis) or swelling of the lips, tongue and throat (angioedema).
- Nasal polyps associated with swelling of the lips, eyes and mouth (angioneurotic oedema).
- Active peptic ulcer or bleeding in the gut, or a history of this.
- Severe liver failure.
- Severe kidney failure.
- Severe heart failure.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine in pregnancy has not been established. It should not be taken by women who are pregnant, and women who could get pregnant should use an effective method of contraception to prevent pregnancy while taking this medicine. Seek further medical advice from your doctor.
- There is no information available about the safety of this medicine during breastfeeding. For this reason, the manufacturer states that it should not be used during breastfeeding. Seek medical advice from your doctor.
- Take this medication with or after food.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Disturbances of the gut such as diarrhoea, constipation, indigestion, nausea, vomiting or abdominal pain.
- Blurred vision.
- Difficulty sleeping (insomnia).
- Ulceration or bleeding in the stomach or intestine.
- Spinning sensation (vertigo).
- Sensation of ringing, or other noise in the ears (tinnitus).
- Flushing of the skin due to widening of the small blood vessels (erythema).
- Loss of appetite.
- Hair loss (alopecia).
- Retention of water in the body tissues (fluid retention), resulting in swelling (oedema).
- Allergic reaction (hypersensitivity) such as facial flushing, skin rash, itch, or swelling of lips, tongue or throat (angioedema).
- Chest pain.
- Kidney, liver or blood disorders.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before taking this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
Acemetacin should not be used in combination with painkilling doses of aspirin or any other NSAID taken by mouth, eg ibuprofen, as this increases the risk of side effects on the stomach and intestines. Selective inhibitors of cyclo-oxgenase 2 such as celecoxib or etoricoxib should also be avoided for the same reason.
There may be an increased risk of ulceration or bleeding from the gut if acemetacin is taken with corticosteroids such as prednisolone.
There may also be an increased risk of bleeding from the gut if acemetacin is taken with the following medicines:
- anti-blood-clotting (anticoagulant) medicines such as warfarin
- anti-platelet medicines to reduce the risk of blood clots or 'thin the blood', eg low-dose aspirin, clopidogrel, dipyridamole
- selective serotonin re-uptake inhibitors (SSRIs) antidepressants, eg fluoxetine, paroxetine, citalopram
Acemetacin may enhance the effect of blood-thinning or anti-clotting medicines (anticoagulants) such as warfarin. As this may increase the risk of bleeding, people taking acemetacin with an anticoagulant should be closely monitored by their doctor.
There may be an increased risk of side effects on the kidneys if acemetacin is used with any of the following medicines:
- ACE inhibitors, eg enalapril
- angiotensin II receptor antagonists, eg losartan
- diuretics, eg furosemide
Acemetacin may oppose the blood pressure lowering effects of certain medicines to treat high blood pressure, including the following:
- ACE inhibitors such as captopril
- angiotensin II receptor antagonists, eg losartan
- beta-blockers such as propranolol
- diuretics such as furosemide.
Acemetacin may reduce the removal of the following medicines from the body and so may increase the blood levels and risk of side effects of these medicines. People using acemetacin with any of these should be closely monitored by their doctor:
The following medicines may increase the blood level of this medicine, which may increase the risk of side effects:
If this medicine is taken with the antipsychotic medicine haloperidol there may be a risk of profound drowsiness and confusion.
If this medicine is used in combination with quinolone antibiotics, such as ciprofloxacin or norfloxacin, there may be an increased risk of seizures (fits). This may occur in people with or without a previous history of epilepsy or convulsions.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain acemetacin as the active ingredient.