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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term symptomatic relief of mild to moderate pain. It is not indicated for chronic pain management.
## Primary Indications
* Pain, including menstrual pain (dysmenorrhea)
* Pain associated with dental procedures
* Musculoskeletal pain
## Adult Dosing
* **Initial dose:** 500 mg
* **Subsequent doses:** 250 mg every 6 hours as needed.
* **Maximum daily dose:** 1500 mg (for short-term use). Longer courses may require adherence to a lower maximum daily dose depending on local guidelines and patient factors.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age due to a lack of established dosing and potential safety concerns.
## 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, 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.
* Active gastrointestinal (GI) bleeding or a history of recurrent GI ulceration/bleeding.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
## Adverse Effects
Common adverse effects include:
* GI disturbances (nausea, vomiting, diarrhea, abdominal pain, dyspepsia)
* Dizziness
* Headache
* Rash
Serious adverse effects include:
* Cardiovascular thrombotic events (myocardial infarction, stroke)
* GI perforation, ulceration, and bleeding
* Hepatotoxicity
* Nephrotoxicity (including interstitial nephritis, papillary necrosis, and renal failure)
* Hypersensitivity reactions (including Stevens-Johnson syndrome and toxic epidermal necrolysis)
* Anemia
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Diuretics and antihypertensives:** May reduce efficacy and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* **GI symptoms:** Monitor for signs of bleeding or ulceration.
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Monitor LFTs, especially in patients with pre-existing liver disease.
* **Blood pressure:** NSAIDs can increase blood pressure.
* **Signs of cardiovascular events:** Monitor for chest pain, shortness of breath, weakness, slurring of speech.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only.
* Administer with food or milk to minimize GI upset.
* Avoid concomitant use with other NSAIDs.
* Consider the risk of GI bleeding, cardiovascular events, and renal toxicity, particularly in elderly patients or those with risk factors.
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This information is intended for healthcare professionals and does not replace the need to consult the most current prescribing information and relevant clinical guidelines for specific patient management. Always verify current drug information before use.
