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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term treatment of mild to moderate pain and for the relief of primary dysmenorrhea. It inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain (e.g., dental pain, post-operative pain)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting with the onset of pain or bleeding.
The maximum daily dose should not exceed 1250 mg. Treatment duration should generally not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally **not recommended** for use in children younger than 14 years due to lack of established safety and efficacy data.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Avoid in severe renal failure.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Avoid in severe hepatic failure.
## Contraindications
* 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.
* Inflammatory bowel disease (active or history).
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, headache, rash.
Serious: Gastrointestinal bleeding, ulceration, perforation, myocardial infarction, stroke, renal failure, hepatic failure, hypersensitivity reactions, exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors and ARBs:** May reduce antihypertensive effect and increase risk of renal dysfunction.
* **Diuretics:** May reduce diuretic effect and increase risk of renal dysfunction.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider risk factors for GI bleeding (e.g., history of ulcers, concurrent anticoagulation).
* Avoid concurrent use with other NSAIDs.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on patient-specific factors and local institutional protocols.
