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# Mefenamic Acid
## Overview
Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) used for the short-term treatment of mild to moderate pain, particularly in gynecological conditions and in the management of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg (equivalent to 3 doses of 500 mg).
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, starting with the onset of pain or bleeding and continuing for the duration of symptoms, not to exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally **not recommended** for use in pediatric patients younger than 14 years of age for pain management. Efficacy and safety have not been established in this population for this indication.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised due to potential for NSAID-induced renal toxicity. Consult prescribing information for specific guidance.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs
* History of bronchospasm, 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 of)
* Severe heart failure
* Severe renal impairment (CrCl < 30 mL/min)
* Severe hepatic impairment
## Adverse Effects
Common adverse effects include gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dyspepsia, headache, dizziness, and rash. Serious adverse effects include gastrointestinal bleeding, ulceration, perforation, renal toxicity, cardiovascular thrombotic events, hypersensitivity reactions, and hepatic impairment.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal adverse effects and bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors and ARBs:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic and antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Renal function (BUN, creatinine).
* Hepatic function (LFTs), especially with prolonged use.
* Blood pressure.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only (typically up to 7 days).
* It should be taken with food or milk to minimize gastrointestinal upset.
* Due to its potential for serious gastrointestinal and cardiovascular side effects, it should be used at the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use with other NSAIDs.
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*Please verify current prescribing information for the most up-to-date and complete details.*
