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# Mefenamic acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain.
## Primary Indications
* Pain associated with dysmenorrhea
* Other mild to moderate pain (e.g., headache, dental pain, muscle pain)
## Adult Dosing
* **Initial dose:** 500 mg orally every 8 hours.
* **Maximum daily dose:** 1500 mg.
* **Duration:** Limit use to a maximum of 7 days.
## Pediatric Dosing
* **Children 6 months to 14 years:** 6.5 mg/kg orally every 8 hours.
* **Maximum dose:** Should not exceed the adult maximum dose.
* **Note:** Dosing for children under 6 months is not established.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, however, caution is advised, and use may be contraindicated in severe impairment.
## Contraindications
* Known 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
Common adverse effects include:
* Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation.
* Central nervous system: Dizziness, drowsiness.
* Other: Headache, rash, tinnitus.
Serious adverse effects include:
* Gastrointestinal: Ulceration, bleeding, perforation.
* Cardiovascular: Increased risk of myocardial infarction and stroke.
* Renal: Renal failure, interstitial nephritis.
* Hepatic: Liver injury.
* Hematologic: Anemia, leukopenia.
## 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 adverse effects, particularly gastrointestinal bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal and hepatic function, especially in patients with pre-existing impairment.
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Avoid concurrent use with other NSAIDs.
* Consider gastroprotection (e.g., PPI) for patients at high risk of GI complications.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and product literature, or a qualified healthcare provider, for definitive guidance.
