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# Mefenamic acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic and anti-inflammatory properties. It works by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Short-term management of mild to moderate pain, including dysmenorrhea.
* Inflammatory conditions.
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed.
* **Maximum:** 1500 mg per day. Treatment duration typically limited to 7 days.
## Pediatric Dosing
* Generally not recommended for children under 14 years of age due to lack of established safety and efficacy data.
* When used, dosing should be individualized under strict medical supervision.
## Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Mefenamic acid can precipitate renal failure in patients with pre-existing renal disease.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* History of 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 bleeding or ulceration.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation, renal failure, hepatic dysfunction, cardiovascular thrombotic events, hypersensitivity reactions (including Stevens-Johnson syndrome and anaphylaxis).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels, potentially leading to toxicity.
* **Methotrexate:** Increased methotrexate 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 taking concomitant nephrotoxic agents.
* Monitor hepatic function.
* Assess for signs of hypersensitivity reactions.
## Clinical Pearls
* Due to its gastrointestinal side effects, it is often recommended to take with food or milk.
* Limit duration of use to the shortest effective period.
* Avoid concurrent use with other NSAIDs.
* Be aware of the potential for diarrhea, which can be dose-limiting.
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**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information with the manufacturer's official product literature or a reliable drug information database before making any clinical decisions.
