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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) of the anthranilic acid derivative class. It functions by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain, including menstrual pain (dysmenorrhea) and pain associated with dental procedures.
* Inflammation.
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg every 8 hours as needed. Do not exceed 7 days of continuous use for self-medication or 14 days for prescription use without medical supervision.
* **Maximum Daily Dose:** 1500 mg.
## Pediatric Dosing
* Not recommended for children under 14 years of age due to limited 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.
* **Elderly:** Increased risk of adverse effects. Consider lower doses and closer monitoring.
## Contraindications
* Known hypersensitivity to mefenamic acid 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 (GI) bleeding or history of recurrent GI ulcers/bleeding.
* Severe renal, hepatic, or heart failure.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, 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 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 adverse effects, particularly GI.
* **Diuretics/ACE Inhibitors/ARBs:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium/Methotrexate:** Increased serum concentrations and potential toxicity.
## Monitoring
* **Renal function:** Baseline and periodic monitoring, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Baseline and periodic monitoring, especially in patients with pre-existing hepatic disease or those at risk.
* **Gastrointestinal symptoms:** Monitor for signs and symptoms of bleeding or ulceration.
* **Cardiovascular risk factors:** Assess and monitor.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Short-term use is recommended due to potential for serious GI and cardiovascular events.
* Avoid concomitant use with other NSAIDs.
* Use the lowest effective dose for the shortest duration necessary.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for complete details and to confirm the accuracy of this information before making any treatment decisions.*
