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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain, including menstrual pain. It works by inhibiting prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 4 to 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg every 4 to 6 hours as needed, starting with the onset of pain or bleeding.
The maximum daily dose should not exceed 1250 mg. Treatment duration typically should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is **not recommended** for use in children under 14 years of age due to limited data on efficacy and safety.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustments are established, but dose reduction may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are established.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, allergic rhinitis, or urticaria following aspirin or other NSAID administration.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, abdominal pain, constipation, and rash. Serious adverse effects can include gastrointestinal bleeding, perforation, ulceration, cardiovascular thrombotic events, renal failure, hepatic failure, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE inhibitors and Angiotensin II Receptor Blockers (ARBs):** May decrease antihypertensive effect and increase risk of renal impairment.
* **Diuretics:** May decrease diuretic effect and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy.
* Assess for signs of cardiovascular events.
* Monitor for hypersensitivity reactions.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to its potential for gastrointestinal side effects, it is generally recommended for short-term use only.
* Ensure patients are aware of the risk of serious cardiovascular and gastrointestinal events associated with NSAID use.
* It is not a substitute for aspirin in the prevention of cardiovascular events.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
