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# Mefanamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the anthranilic acid derivative class. It exhibits analgesic and anti-inflammatory properties.
## Primary Indications
* Dysmenorrhea
* Mild to moderate pain (e.g., headache, muscle pain, dental pain)
## Adult Dosing
* **Dysmenorrhea:** 500 mg every 4-6 hours as needed. Do not exceed 1250 mg per day. Therapy should not exceed 5 days per menstrual cycle.
* **Mild to moderate pain:** 500 mg every 4-6 hours as needed. Do not exceed 1250 mg per day. Therapy should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to lack of established safety and efficacy data.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, renal failure, hepatotoxicity, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly gastrointestinal.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels. Monitor lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function tests (LFTs).
* Blood pressure.
## Clinical Pearls
* Short-term use only for pain indications.
* Take with food or milk to minimize gastrointestinal upset.
* Avoid concomitant use with other NSAIDs or aspirin.
* Advise patients to report any signs of bleeding or cardiovascular events.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and clinical guidelines for definitive guidance. Dosing may vary based on individual patient factors and local protocols.
