In Pakistan, the use of pain-relieving suspension in children has become almost routine. One of the most commonly used medications is Dolor Suspension, which contains Mefenamic Acid a non-steroidal anti-inflammatory drug (NSAID). While it can be effective for short-term pain and inflammation, its misuse and over-prescription, particularly among children, have become a growing public health concern.
MEFENAMIC ACID: WHAT IT IS AND WHAT GLOBAL GUIDELINES SAY
To understand the issue, it’s important to first recognize what Mefenamic Acid actually does. It works by inhibiting prostaglandin synthesis chemicals responsible for causing pain, fever, and inflammation. However, despite its ability to relieve discomfort, this medication is not recommended as a first-line treatment for fever in children.
According to the World Health Organization (WHO) Model List of Essential Medicines for Children (2023), only paracetamol (acetaminophen) and ibuprofen are approved for managing pediatric fever. Similarly, both the American Academy of Pediatrics (AAP) and the UK National Institute for Health and Care Excellence (NICE) state that:
“Paracetamol and ibuprofen remain the preferred agents for fever and mild pain in children due to their well-established safety and efficacy profiles.”
In contrast, Mefenamic Acid is mainly indicated for menstrual pain and moderate inflammatory conditions in older adolescents and adults not for routine use in children.
THE PAKISTANI REALITY: WHEN STRONG DRUGS BECOME COMMONPLACE
Unfortunately, the situation in Pakistan tells a very different story. Despite being a prescription drug, Dolor Suspension is widely available over the counter. Many parents use it to treat fever, toothache, or flu-related pain, often without professional advice. This practice is fueled by a common misconception that stronger painkillers offer quicker relief.
Moreover, the combination of easy accessibility, habitual prescribing, and a lack of regulatory oversight has allowed Mefenamic Acid to become a household name. As a result, many mothers now consider it their first choice for fever, even though safer and scientifically validated alternatives exist.
Research published in the Pakistan Journal of Medical Sciences (2021) revealed that over 60% of parents self-medicate their children, often using NSAIDs without consulting healthcare professionals.
Similarly, data from the Drug Regulatory Authority of Pakistan (DRAP) highlight a rise in NSAID-related gastrointestinal and renal complications in children under 12.
The HIDDEN RISKS OF MISUSE
When Mefenamic Acid is used improperly especially over long periods or in high doses it can cause harm that extends far beyond temporary relief.
1. Gastrointestinal Damage
Firstly, Mefenamic Acid inhibits enzymes (COX-1 and COX-2) that protect the stomach lining. As a result, it can lead to nausea, vomiting, or gastritis.
A study in the European Journal of Pediatrics (2018) reported a higher incidence of gastrointestinal discomfort and vomiting with Mefenamic Acid compared to ibuprofen. In severe cases, it can even cause gastric bleeding.
2. Kidney Stress
Secondly, prolonged use can burden the kidneys. NSAIDs reduce renal blood flow by interfering with prostaglandin activity.
A 2019 review in Pediatric Nephrology found that children repeatedly exposed to NSAIDs during illness or dehydration are at increased risk of acute kidney injury (AKI).
This is particularly relevant in Pakistan’s hot climate, where dehydration is common.
3. Liver and Metabolic Burden
Furthermore, combining Mefenamic Acid with other painkillers can increase liver enzyme levels, especially in children whose liver function is still developing.
A Clinical Pharmacology & Therapeutics (2020) meta-analysis noted that improper NSAID use can contribute to hepatic stress and metabolic imbalance over time.
4. Altered Health Behavior
Beyond physical risks, frequent use of painkillers for minor ailments can shape unhealthy attitudes toward medication. Over time, children may develop a psychological dependence on drugs for comfort. Studies suggest this early exposure may encourage self-medication habits and reduced pain tolerance in adolescence.
EMERGING CONCERNS IN EARLY CHILDHOOD HEALTH
Interestingly, recent pediatric nutrition guidelines emphasize that sugar and salt should not be given to children under two years of age, as they can put unnecessary stress on developing kidneys. However, in Pakistan, the irrational use of Mefenamic Acid in infants and toddlers poses a similar if not greater threat. When such potent medications are introduced early and repeatedly, they can burden the kidneys and liver, the very organs still maturing to handle metabolic stress. This concerning trend reflects how misguided medical practices and over-the-counter misuse can quietly set the stage for long-term health issues in children.
SCIENTIFIC EVIDENCE
A 2023 review in the International Journal of Pediatrics and Child Health reported that NSAID induced kidney injury is increasingly observed among children, particularly in low- and middle-income countries where over the counter access is unregulated.
Similarly, research published in Frontiers in Pharmacology (2022) noted that Mefenamic Acid should not be used in children under 12 years unless prescribed by a specialist, due to its narrow therapeutic margin and hepatic metabolism.
These studies highlight the importance of rational prescribing practices a standard that needs urgent reinforcement in Pakistan’s healthcare landscape.
WHY THIS MISUSE PERSISTS
This ongoing misuse is not simply a parental mistake it reflects systemic weaknesses in health education and pharmacy regulation. In many community settings, medications are sold freely without verifying age, dosage, or indication.
A 2017 study in the Journal of Pharmacy Practice and Research found that over half of pharmacists in South Asia had dispensed Mefenamic Acid without confirming its suitability for children. This points to a significant need for professional training and public awareness.
THE PHARMACIST’S ROLE: BRIDGING KNOWLEDGE AND SAFETY
Pharmacists play a crucial role in ensuring rational drug use. They are often the first and sometimes the only healthcare professionals’ parents consult. Therefore, active counseling and education can make a real difference.
• Educate before dispensing: Pharmacists should explain that fever is often a natural immune response, not always a cause for alarm.
• Promote safer options: Paracetamol and ibuprofen, when dosed properly, remain the internationally accepted first-line treatments for fever and mild pain.
• Discourage OTC availability: Mefenamic Acid should be dispensed only on prescription, as practiced in most developed countries.
• Encourage non-drug measures: Rest, hydration, and lukewarm sponging can safely help reduce mild fever without medication.
LONG TERM HEALTH IMPACT
Over time, repeated exposure to potent NSAIDs can have lasting consequences.
Studies in Frontiers in Pharmacology (2022) emphasize that early misuse of such drugs predisposes children to chronic gastric issues, kidney stress, and altered pain sensitivity as they grow older.
In other words, what begins as a seemingly harmless syrup can silently undermine long-term health. This underscores the urgent need for stricter regulations and consistent parental education.
CONCLUSION
In conclusion, while Mefenamic Acid (Dolor Suspension) has valid medical uses, it should not be the first choice for fever or mild pain in children. Unfortunately, in Pakistan, its widespread misuse reflects a gap between scientific evidence and everyday medical practice.
By aligning local habits with international pediatric standards and promoting awareness among parents and healthcare workers alike, we can significantly reduce unnecessary risks. Rational prescribing begins with informed decisions and pharmacists, as guardians of safe medicine use, must lead this change.
When science and community awareness work hand in hand, we not only protect our children’s present comfort but also secure their long-term health and resilience.
FAQs
1. What is Dolar Suspension and what does it contain?
Dolor Suspension contains Mefenamic Acid, a non-steroidal anti-inflammatory drug (NSAID) used to relieve moderate pain and inflammation. It is not recommended as a first-line treatment for fever in children.
2. Can Mefenamic Acid be safely given to children?
According to the World Health Organization (WHO) and the American Academy of Pediatrics (AAP), Mefenamic Acid should not be used routinely in children under 12 years. Paracetamol and ibuprofen are safer and globally recommended alternatives.
3. What are the risks of using Mefenamic Acid in children?
Prolonged or improper use can cause gastric irritation, kidney stress, liver strain, and metabolic imbalance. In some cases, it can lead to gastrointestinal bleeding or acute kidney injury (AKI).
4. Why is Dolar Suspension misused in Pakistan?
Misuse occurs due to easy over the counter availability, lack of parental awareness, and habitual prescribing practices. Many people wrongly assume that stronger painkillers offer faster relief.
5. What can parents do instead of using Dolar Suspension?
Parents should consult a pharmacist or pediatrician before giving any medicine. For mild fever or pain, paracetamol and ibuprofen are effective when used at correct doses. Non-drug measures like hydration, rest, and lukewarm sponging also help.
6. What role do pharmacists play in preventing misuse?
Pharmacists should educate parents, discourage over the counter sales, and promote rational medicine use. They serve as the first line of defense against unsafe self-medication.
DISCLAIMER
This article is intended for educational purposes only and should not be taken as a substitute for professional medical advice. Always consult a qualified healthcare provider or pharmacist before administering any medication to children. The information provided reflects current evidence and international guidelines but may vary depending on individual clinical circumstances.
CALL TO ACTION
• Parents and caregivers before reaching for pain syrups, pause and ask your pharmacist.
• Promote safe medicine use by sharing awareness in your community. Together, we can protect children’s health and build a culture of evidence-based care in Pakistan.
• Stay informed. Choose wisely. Consult your pharmacist before you medicate.
REFERENCES
1. World Health Organization (2023). Model List of Essential Medicines for Children.
2. American Academy of Pediatrics (AAP) & NICE Guidelines. Management of Fever and Mild Pain in Children.
3. Pakistan Journal of Medical Sciences (2021). Parental Self-Medication Practices and NSAID Use in Children.
4. Drug Regulatory Authority of Pakistan (DRAP). NSAID Safety Reports in Pediatric Populations.
5. European Journal of Pediatrics (2018). Comparative Safety of Mefenamic Acid and Ibuprofen in Children.
6. Pediatric Nephrology (2019). NSAID-Induced Acute Kidney Injury in Children: Risk Factors and Mechanisms.
7. Clinical Pharmacology & Therapeutics (2020). Hepatic Stress and NSAID Misuse in Pediatric Populations.
8. International Journal of Pediatrics and Child Health (2023). NSAID-Induced Renal Injury in Low- and Middle-Income Countries.
9. Frontiers in Pharmacology (2022). Safety Profile of Mefenamic Acid in Pediatric Use. 10. Journal of Pharmacy Practice and Research (2017). Dispensing Behavior of Pharmacists in South Asia: A Review.