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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic and anti-inflammatory properties. It is a non-selective COX inhibitor.
## Primary Indications
* Short-term management of mild to moderate pain.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Pain:** 500 mg every 4 to 6 hours as needed. Maximum daily dose is 1500 mg.
* **Dysmenorrhea:** 500 mg every 4 to 6 hours as needed, starting with the onset of pain and bleeding. Maximum daily dose is 1500 mg. Treatment should not exceed 7 days per month.
## Pediatric Dosing
* Mefenamic acid is generally not recommended for children under 14 years of age due to lack of established dosing and potential for adverse effects.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary, though specific guidelines are not well-established. Monitor renal function closely.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary, though specific guidelines are not well-established. Monitor hepatic function closely.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria induced by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal ulceration or bleeding.
* Severe renal or hepatic impairment.
* Late pregnancy (third trimester).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic failure; cardiovascular thrombotic events (MI, stroke); hypersensitivity reactions (including anaphylaxis); bronchospasm; Stevens-Johnson syndrome, toxic epidermal necrolysis; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly gastrointestinal.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Renal function (BUN, creatinine).
* Hepatic function (LFTs).
* Blood pressure.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concurrent use with other NSAIDs.
* Advise patients to report any signs of bleeding, including black tarry stools or hematemesis.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and a qualified healthcare provider for any medical condition or treatment.*
