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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the fenamate class. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Short-term management of mild to moderate pain.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Maximum daily dose: 1500 mg.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting with the onset of pain and bleeding. Treatment duration typically 2-3 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to limited data and potential for increased risk of adverse effects.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment is universally established, but reduced doses or avoidance may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is universally established, but reduced doses or avoidance may be considered in severe impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of gastrointestinal bleeding or perforation related to prior NSAID use.
* Active peptic ulceration or history of recurrent peptic ulceration.
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, and rash. Serious adverse effects may include gastrointestinal bleeding, ulceration, perforation, cardiovascular thrombotic events, renal and hepatic toxicity, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor for signs of cardiovascular events (e.g., chest pain, shortness of breath).
* Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing organ dysfunction.
* Assess pain and inflammatory response.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only.
* Administer with food or milk to minimize gastrointestinal upset.
* Advise patients to report any signs of bleeding, allergic reaction, or cardiovascular symptoms.
* Consider alternatives for patients with a history of peptic ulcer disease or significant cardiovascular risk factors.
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*Disclaimer: This information is intended for clinical professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Local protocols may influence dosing and management.*
