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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of mild to moderate pain, including menstrual pain.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg every 6 hours, starting at the onset of pain or bleeding, whichever comes first, for up to 3 days.
* **Maximum Dose:** 1500 mg per day.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age due to limited safety and efficacy data.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dosing may need to be reduced in severe impairment.
* **Hepatic Impairment:** Use with caution. Dosing may need to be reduced in severe impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* 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.
* Inflammatory bowel disease.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, abdominal pain, constipation, rash, and dizziness. Serious adverse effects 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 ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of gastrointestinal side effects and potential for reduced cardioprotective effects of low-dose aspirin.
* **Diuretics:** Reduced efficacy of diuretics and increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor for signs and symptoms of renal toxicity (e.g., changes in urine output, edema).
* Monitor for signs and symptoms of cardiovascular events.
* Monitor liver function tests periodically, especially with long-term use.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Limit use to the shortest duration necessary.
* Avoid concomitant use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) for patients at increased risk of gastrointestinal events.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.
