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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain. It works by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain, including menstrual pain (dysmenorrhea) and pain associated with inflammation.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding.
* **Maximum Dose:** Not to exceed 4000 mg per day. Treatment duration is generally limited to 7 days.
## Pediatric Dosing
Mefenamic acid is generally **not recommended for children under 14 years of age** due to limited data and potential safety concerns. Specific pediatric dosing is not established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment. Data is limited.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe hepatic impairment. Data is limited.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* 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 ulceration.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal adverse effects.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics and Antihypertensives:** Reduced efficacy; increased risk of renal impairment.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Especially in patients with pre-existing hepatic disease.
* **Signs of gastrointestinal bleeding:** Such as melena, hematemesis, or abdominal pain.
* **Blood pressure:** NSAIDs can elevate blood pressure.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* It is intended for short-term use only.
* Consider the risks of gastrointestinal and cardiovascular adverse events, particularly in elderly patients or those with a history of these conditions.
* Avoid concomitant use with other NSAIDs.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines before administering any medication.*
