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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. It functions by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## 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, started at the onset of pain or bleeding, whichever comes first, and continued for up to 3 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age due to lack of established safety and efficacy data.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution and lower doses may be considered due to potential for exacerbating existing organ dysfunction.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of gastrointestinal (GI) bleeding or perforation related to prior NSAID use.
* Active peptic ulceration or a history of recurrent peptic ulceration/hemorrhage.
* Severe heart failure.
* Use during the third trimester of pregnancy.
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, constipation, and dizziness. Serious adverse effects include GI bleeding/perforation, renal toxicity, cardiovascular thrombotic events, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI symptoms:** Monitor for signs and symptoms of GI bleeding or ulceration.
* **Renal function:** Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* **Blood pressure:** Monitor blood pressure, as NSAIDs can increase it.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Limit treatment duration to the shortest effective period to reduce risks.
* Avoid concomitant use with other NSAIDs.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
