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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.
## Primary Indications
* Dysmenorrhea
* Mild to moderate pain (e.g., dental pain, musculoskeletal pain)
## Adult Dosing
* **Initial dose:** 500 mg orally.
* **Subsequent doses:** 250 mg orally every 6 hours as needed.
* **Maximum daily dose:** 750 mg orally.
* **Duration of therapy:** Generally limited to 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to insufficient data on safety and efficacy.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary, but specific guidelines are not established. Monitor renal function closely.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary, but specific guidelines are not established. Monitor hepatic function closely.
* **Elderly:** Use with caution. Increased risk of adverse effects, particularly gastrointestinal bleeding and renal dysfunction. Lower doses may be considered.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, 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 (active or history of).
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation, renal failure, hepatotoxicity, cardiovascular thrombotic events, hypersensitivity reactions, bronchospasm.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal adverse effects.
* **Diuretics:** Reduced diuretic efficacy; increased risk of nephrotoxicity.
* **ACE Inhibitors and ARBs:** Increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Renal function:** Serum creatinine, BUN.
* **Hepatic function:** Liver enzymes (AST, ALT).
* **Gastrointestinal symptoms:** Watch for signs of bleeding or ulceration.
* **Blood pressure:** NSAIDs can increase blood pressure.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to potential for dizziness and drowsiness, patients should exercise caution when operating machinery or driving.
* Treatment duration should be as short as possible to minimize risks.
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*Please verify current prescribing information with official product labeling or other reliable resources before making clinical decisions.*
