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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term management of mild to moderate pain.
## Primary Indications
* Primary dysmenorrhea
* Mild to moderate pain (e.g., dental pain, musculoskeletal pain)
## Adult Dosing
* **Dysmenorrhea:** 500 mg every 4 to 6 hours as needed.
* **Other Pain:** 500 mg initially, followed by 250 mg every 4 to 6 hours as needed.
* **Maximum Dose:** 1500 mg per 24 hours. Treatment should not exceed 7 days.
## Pediatric Dosing
* Mefenamic acid is **not recommended** for use in children under 14 years of age due to lack of established 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.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, 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.
* Severe renal or hepatic impairment.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, headache, dizziness, 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 gastrointestinal adverse effects.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of gastrointestinal adverse effects and potential for additive pharmacologic effects.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding.
* Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those receiving concurrent nephrotoxic agents.
* Monitor hepatic function (LFTs) periodically.
* Assess pain relief and for adverse effects.
## Clinical Pearls
* Mefenamic acid is generally intended for short-term use only.
* Administer with food or milk to reduce gastrointestinal upset.
* The risk of cardiovascular thrombotic events, myocardial infarction, and stroke associated with NSAID use may occur early in treatment and may increase with duration of use.
* NSAIDs, including mefenamic acid, can cause serious gastrointestinal bleeding, ulceration, and perforation at any time during treatment.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant literature for complete details before making any clinical decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
