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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of mild to moderate pain, including menstrual pain.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg.
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, starting with the onset of pain and continuing for the duration of dysmenorrhea. Maximum daily dose is 1500 mg. Treatment duration typically 2-3 days.
## Pediatric Dosing
Mefenamic acid is not generally recommended for use in pediatric patients for pain relief. Data is limited and it's often reserved for specific indications under specialist guidance.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Consider dose reduction. Not recommended in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Consider dose reduction. Not recommended in severe hepatic impairment.
* **Elderly:** Use with caution due to increased risk of adverse effects, particularly gastrointestinal bleeding and renal events.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of gastrointestinal bleeding or perforation related to previous NSAID therapy.
* Active peptic ulceration or history of recurrent peptic ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal impairment; cardiovascular thrombotic events; hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis; hepatic impairment.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Aspirin:** May reduce the cardioprotective effects of low-dose aspirin.
* **Other NSAIDs:** Increased risk of adverse effects.
* **ACE inhibitors/ARBs/Diuretics:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **Renal function:** Particularly in patients with pre-existing renal disease, elderly patients, or those on concomitant nephrotoxic agents.
* **Hepatic function:** Monitor for signs of liver injury.
* **Gastrointestinal symptoms:** Watch for any signs of bleeding or ulceration.
* **Blood pressure:** Especially in patients with hypertension.
## Clinical Pearls
* Mefenamic acid is generally for short-term use only.
* Administer with food or milk to minimize gastrointestinal upset.
* Discontinue if diarrhea occurs.
* Avoid concurrent use with other NSAIDs.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
