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# Mefenamic acid (meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of mild to moderate pain.
## Primary Indications
* Pain associated with dysmenorrhea
* Mild to moderate pain (e.g., headache, toothache, muscle pain)
## Adult Dosing
* **Initial dose:** 500 mg orally every 4-6 hours as needed.
* **Maximum dose:** 1500 mg per day.
* **Duration:** Typically for no more than 7 days.
## Pediatric Dosing
* Mefenamic acid is **not recommended** for children under 14 years of age due to insufficient safety and efficacy data.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustments are established, but dose reduction may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. No specific dose adjustments are established.
## Contraindications
* 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.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, gastrointestinal bleeding, perforation, ulceration.
* **Central Nervous System:** Dizziness, drowsiness, headache.
* **Renal:** Renal impairment, interstitial nephritis.
* **Hematologic:** Anemia, leukopenia.
* **Dermatologic:** Rash, pruritus.
* **Cardiovascular:** Increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.
* **Other:** Bronchospasm (especially in patients with aspirin-sensitive asthma).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics:** Reduced diuretic and antihypertensive effect; increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly gastrointestinal bleeding.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding.
* Assess renal and hepatic function periodically, especially in patients with pre-existing impairment.
* Monitor for signs of cardiovascular events.
* Monitor for hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use with other NSAIDs.
* Patients with a history of peptic ulcer disease or gastrointestinal bleeding should use with extreme caution and may require prophylactic gastroprotection.
* Due to the risk of cardiovascular thrombotic events, consider the indication and risks before prescribing, especially for patients with cardiovascular disease or risk factors.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details and to verify this information before making clinical decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.
