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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term relief of mild to moderate pain. It is also used for primary dysmenorrhea.
## Primary Indications
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg initially, then 250 mg every 6 hours as needed.
* **Maximum Duration:** Typically recommended for use up to 7 days.
## Pediatric Dosing
* Not generally recommended for children under 14 years of age due to lack of established safety and efficacy data.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary based on renal function, though specific guidelines are lacking.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary based on hepatic function, though specific guidelines are lacking.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of gastrointestinal (GI) bleeding or perforation related to prior NSAID use.
* Active peptic ulceration or history of recurrent peptic ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, dizziness, headache, rash.
* **Serious:** GI bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis); cardiovascular thrombotic events; hepatic toxicity; hypersensitivity reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis); worsening of asthma.
## 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.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor renal function (BUN, creatinine) particularly in patients with pre-existing renal disease or those at risk.
* Monitor liver function tests (LFTs) in patients with hepatic impairment or those on prolonged therapy.
* Monitor for cardiovascular risk factors and signs of cardiovascular events.
## Clinical Pearls
* Mefenamic acid has a relatively short half-life and is generally intended for short-term use.
* Administer with food or milk to minimize GI upset.
* Avoid concomitant use with other NSAIDs.
* Due to the risk of renal and GI adverse effects, use the lowest effective dose for the shortest duration necessary.
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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 before making any treatment decisions.*
