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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. It is used for short-term relief of mild to moderate pain.
## Primary Indications
* Pain (e.g., dental pain, menstrual pain)
* Inflammation
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Maximum:** 1500 mg per day. Dosing should not exceed 7 days.
## Pediatric Dosing
* **Age 14 years and older:** Same as adult dosing.
* **Under 14 years:** Safety and efficacy have not been established. Use is generally not recommended.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dosage reduction may be necessary. Specific guidance is limited; consult renal dosing guidelines.
* **Hepatic Impairment:** Use with caution. Dosage reduction may be necessary. Specific guidance is limited; consult hepatic dosing guidelines.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal events. Consider lower doses and shorter duration.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulcer disease.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; Stevens-Johnson syndrome; anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI Bleeding:** Signs and symptoms (e.g., melena, hematemesis, occult blood in stool).
* **Renal Function:** Serum creatinine, BUN.
* **Hepatic Function:** Liver enzymes (AST, ALT).
* **Blood Pressure:** Especially in patients with hypertension.
* **Signs of hypersensitivity reactions.**
## Clinical Pearls
* Mefenamic acid is indicated for short-term use only.
* It should be taken with food or milk to minimize gastrointestinal upset.
* Due to potential adverse effects, use the lowest effective dose for the shortest possible duration.
* Avoid concurrent use with other NSAIDs.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.
