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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain. It is a fenamate derivative.
## Primary Indications
* Pain, mild to moderate (e.g., dysmenorrhea, dental pain, post-operative pain)
## Adult Dosing
* **Initial dose:** 500 mg orally every 8 hours.
* **Maintenance dose:** 250 mg orally every 6 hours as needed.
* **Maximum dose:** Do not exceed 1500 mg in a 24-hour period.
* Treatment duration 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 for adverse effects. If used, consult specific pediatric guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment is typically recommended, but monitor renal function closely.
* **Hepatic Impairment:** Use with caution. No specific dose adjustment is typically recommended, but monitor hepatic function closely.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, 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 (active or history).
* Severe heart failure, renal impairment, or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, dizziness, drowsiness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic failure; cardiovascular thrombotic events; hypersensitivity reactions; exacerbation of asthma; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly gastrointestinal bleeding.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics/ACE inhibitors/ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
## Monitoring
* **Renal function:** Baseline and periodic monitoring, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Baseline and periodic monitoring, especially in patients with pre-existing hepatic disease.
* **Gastrointestinal symptoms:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis).
* **Blood pressure:** Monitor, especially in patients taking antihypertensives.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Short-term use is recommended; efficacy and safety beyond 7 days are not established.
* Due to potential for gastrointestinal side effects, consider risk factors for bleeding and ulceration.
* Avoid concomitant use with other NSAIDs.
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*This information is intended for clinical use and does not substitute for professional medical judgment. Always consult the most current prescribing information and local protocols before making clinical decisions.*
