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# Mefanamic acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term management of mild to moderate pain.
## Primary Indications
* Pain associated with osteoarthritis and rheumatoid arthritis.
* Menstrual pain (primary dysmenorrhea).
## Adult Dosing
* **Pain:** 500 mg every 4-6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg initially, followed by 250 mg every 4-6 hours as needed.
* **Maximum Daily Dose:** 1500 mg.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age. Specific pediatric dosing is not established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction or avoidance in severe impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction or avoidance in severe impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, 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 (GI) bleeding or a history of recurrent GI ulcers or bleeding.
* Severe heart failure, renal impairment, or hepatic impairment.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, headache.
* **Serious:** GI bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; hypersensitivity reactions; severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Other NSAIDs / Aspirin:** Increased risk of GI toxicity and other adverse effects.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Diuretics / ACE Inhibitors / ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
## Monitoring
* **Renal function:** Baseline and periodically.
* **Hepatic function:** Baseline and periodically.
* **Signs and symptoms of GI bleeding/ulceration:** Especially with prolonged use or in high-risk patients.
* **Blood pressure:** NSAIDs can increase blood pressure.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize GI upset.
* Avoid concomitant use with other NSAIDs.
* Discontinue if signs of GI bleeding, renal impairment, or severe adverse effects occur.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.
