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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the anthranilic acid derivative class. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Mild to moderate pain, particularly associated with gynecological conditions.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg every 6 to 8 hours as needed.
* **Maximum:** Not to exceed 1500 mg in a 24-hour period. Therapy should generally not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age due to limited data and potential safety concerns.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Monitor patients closely for signs of organ toxicity.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* History of bronchospasm, 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.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, gastrointestinal bleeding, ulceration, perforation.
* **Central Nervous System:** Dizziness, headache, drowsiness, nervousness.
* **Renal:** Renal insufficiency, interstitial nephritis, papillary necrosis.
* **Hematologic:** Anemia, leukopenia, thrombocytopenia.
* **Dermatologic:** Rash, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Cardiovascular:** Fluid retention, edema, hypertension. Increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.
## 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 lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly gastrointestinal.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function tests (ALT, AST) if liver disease is present or symptoms arise.
* Blood pressure.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* NSAIDs, including mefenamic acid, carry a risk of serious cardiovascular thrombotic events.
* Discontinue use at the first sign of rash, allergic reaction, or gastrointestinal bleeding.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant guidelines for complete details and to confirm suitability for individual patient use.*
