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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 and for the relief of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg orally every 4-6 hours as needed. Maximum daily dose is 1500 mg.
* **Primary Dysmenorrhea:** 500 mg orally every 4-6 hours as needed, starting with the onset of pain or bleeding. Maximum daily dose is 1500 mg.
## Pediatric Dosing
Mefenamic acid is **not recommended** for children under 14 years of age.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment guidelines are established, but dose reduction may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. No specific dose adjustment guidelines are established, but dose reduction may be considered in severe impairment.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* History of aspirin-induced asthma, urticaria, or allergic reactions.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Renal or hepatic failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dyspepsia, headache, dizziness, rash.
* **Serious:** Cardiovascular thrombotic events, myocardial infarction, stroke, gastrointestinal bleeding, ulceration, perforation, acute kidney injury, hepatic failure, anaphylaxis, 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.
* **Other NSAIDs or Salicylates:** Increased risk of adverse effects.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive efficacy, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic efficacy, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* Monitor liver function.
* Monitor for signs of hypersensitivity or severe skin reactions.
* Assess pain relief and menstrual symptom improvement.
## Clinical Pearls
* Mefenamic acid is generally intended for short-term use only.
* It is often prescribed for dysmenorrhea due to its effectiveness in managing uterine cramping and associated pain.
* Take with food or milk to minimize gastrointestinal upset.
* Advise patients to avoid concurrent use with other NSAIDs or aspirin unless specifically directed by a healthcare provider.
* Discontinue use and seek medical attention if signs of gastrointestinal bleeding, cardiovascular events, or severe allergic reactions occur.
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*Disclaimer: This information is intended for healthcare professionals and does not replace the need to consult the most current prescribing information and professional judgment. Dosing and recommendations may vary based on patient-specific factors and local protocols.*
