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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 and for primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg orally every 6 hours, starting at the onset of pain and bleeding, and continuing for up to 3 days.
Maximum daily dose for adults is 1500 mg.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in pediatric patients less than 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. However, NSAIDs should be used with caution in patients with pre-existing renal or hepatic disease.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* 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 heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, constipation, and dizziness. Serious adverse effects include gastrointestinal bleeding, ulceration, perforation, cardiovascular thrombotic events (myocardial infarction, stroke), renal toxicity, hepatic toxicity, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of gastrointestinal bleeding.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Diuretics and Antihypertensives:** May reduce the antihypertensive effect and increase the risk of renal impairment.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor for signs and symptoms of cardiovascular events.
* Monitor renal and hepatic function, especially in patients with pre-existing conditions.
* Assess pain relief and menstrual symptom improvement.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to its potential for serious adverse effects, mefenamic acid should be used for the shortest duration necessary.
* Use in the elderly requires caution due to an increased risk of adverse events.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive patient care decisions. Dosing and indications may vary based on local protocols and specific patient factors.
