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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) belonging to the fenamate class. It exhibits analgesic, anti-inflammatory, and antipyretic properties through the inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Short-term management of mild to moderate pain, including menstrual pain (dysmenorrhea).
* Relief of inflammation associated with certain conditions.
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg orally every 6 hours as needed.
* **Maximum Dose:** 1500 mg per day for short-term use.
## Pediatric Dosing
* **Pain/Inflammation:** 6.5 mg/kg orally every 6 hours as needed.
* **Maximum Dose:** Not to exceed 500 mg per dose or 1500 mg per day.
* **Age Restriction:** Generally not recommended for children under 14 years of age without specific guidance.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment; consult prescribing information.
* **Hepatic Impairment:** Use with caution. Patients with liver disease may be more susceptible to adverse effects.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or history of recurrent GI ulcers or bleeding.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic impairment; cardiovascular thrombotic events (MI, stroke); hypersensitivity reactions; bronchospasm; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Other NSAIDs/Aspirin:** Increased risk of GI adverse effects and bleeding.
## Monitoring
* **Renal function:** Especially in elderly patients or those with pre-existing renal disease.
* **Hepatic function:** Baseline and periodic monitoring may be warranted.
* **GI symptoms:** Assess for signs of bleeding or ulceration.
* **Blood pressure:** Especially if used concomitantly with antihypertensives.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Limit duration of use to the shortest effective period due to risk of GI and cardiovascular events.
* Consider alternative analgesics for patients with a history of GI ulcers or bleeding, or cardiovascular disease.
* Ensure adequate hydration, particularly in pediatric patients.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before initiating treatment.*
