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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 and menstrual pain (dysmenorrhea).
## 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, whichever occurs first.
**Maximum Daily Dose:** 1500 mg. Doses higher than 1500 mg/day are not recommended. Treatment should not exceed 7 days.
## Pediatric Dosing
* Not recommended for children under 14 years of age for pain management due to lack of established efficacy and safety.
* For dysmenorrhea, it is generally not recommended for patients under 14 years of age.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be considered in severe impairment, but specific guidelines are not well-established.
* **Hepatic Impairment:** Use with caution. Dose reduction may be considered in severe impairment, but specific guidelines are not well-established.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of gastrointestinal (GI) bleeding or perforation related to prior NSAID use.
* Active peptic ulceration or history of recurrent peptic ulceration/hemorrhage.
* Severe heart failure, renal impairment, or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, dizziness, headache.
* **Serious:** GI bleeding, ulceration, perforation; renal failure; hepatic failure; cardiovascular thrombotic events; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI adverse effects.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Diuretics, ACE inhibitors, Angiotensin II Receptor Blockers (ARBs):** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal and hepatic function, especially with long-term use or in patients with pre-existing impairment.
* Blood pressure.
* For patients with a history of cardiovascular disease, monitor for signs of cardiovascular events.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only.
* It should be taken with food or milk to minimize GI upset.
* Due to the risk of diarrhea, it is generally not a first-line agent for pain management if other NSAIDs are suitable.
* Discontinue if diarrhea occurs.
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***Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant guidelines before making clinical decisions.*
