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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 acts by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain (e.g., dysmenorrhea, dental pain, musculoskeletal pain)
* Inflammation
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Maximum:** Not to exceed 4000 mg per day. Therapy duration typically should not exceed 7 days.
## Pediatric Dosing
* **Age < 14 years:** Safety and efficacy have not been established. Use is generally not recommended.
* **Age ≥ 14 years:** Same as adult dosing (500 mg every 6 hours as needed).
## Dose Adjustments
* **Renal Impairment:** Use with caution; may require dose reduction. Specific guidelines are not well-established.
* **Hepatic Impairment:** Use with caution; may require dose reduction. Specific guidelines are not well-established.
* **Elderly:** Increased risk of adverse effects; consider lower doses.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of gastrointestinal bleeding or perforation related to previous NSAID use.
* Active peptic ulceration or history of recurrent peptic ulceration.
* Severe renal, hepatic, or cardiac impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation.
* **Serious:** Gastrointestinal bleeding, perforation, ulceration; renal toxicity (including interstitial nephritis, papillary necrosis); hepatic dysfunction; cardiovascular events (MI, stroke); hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Other NSAIDs or Salicylates:** Increased risk of adverse effects, particularly gastrointestinal.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Renal function (especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents).
* Liver function tests.
* Blood pressure.
## Clinical Pearls
* Should be taken with food or milk to minimize gastrointestinal upset.
* Not recommended for long-term use due to potential for serious gastrointestinal and cardiovascular events.
* Consider alternative analgesics for patients with a history of peptic ulcer disease or gastrointestinal bleeding.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before initiating therapy.*
