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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. It has anti-inflammatory and analgesic properties.
## Primary Indications
* Mild to moderate pain, particularly menstrual pain (dysmenorrhea).
* Rheumatic conditions (less common due to GI risks).
## Adult Dosing
* **Initial dose:** 500 mg every 6 hours as needed.
* **Maximum daily dose:** 1500 mg.
* **Duration of use:** Typically limited to 7 days for pain management.
## Pediatric Dosing
* **Children 6 months to 12 years:** Dosing is typically weight-based, but specific recommendations vary by country and formulation. A common recommendation is 6.5 mg/kg every 6 hours, not to exceed the adult dose.
* **Note:** Use in children under 6 months is generally not recommended due to safety concerns. Always consult local guidelines and product labeling for specific pediatric dosing.
## Dose Adjustments
* No specific dose adjustments are routinely required for hepatic or renal impairment. However, caution is advised due to potential for renal toxicity with NSAIDs, and close monitoring is recommended.
## 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.
* Active gastrointestinal bleeding or ulceration.
* Severe renal or hepatic impairment.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis); cardiovascular thrombotic events; hypersensitivity reactions; hepatic dysfunction; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May decrease the antiplatelet effect of low-dose aspirin; increased risk of GI toxicity.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and antihypertensives:** May reduce their efficacy and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* **Gastrointestinal:** Monitor for signs and symptoms of GI bleeding (melena, hematemesis) and ulceration.
* **Renal:** Assess renal function (BUN, creatinine) particularly in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic:** Monitor liver function tests if clinically indicated.
* **Cardiovascular:** Be aware of potential cardiovascular risks.
## Clinical Pearls
* Mefenamic acid is generally intended for short-term use only.
* Administer with food or milk to minimize GI upset.
* Due to potential for renal and GI toxicity, use the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use with other NSAIDs.
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**Disclaimer:** This information is intended for clinical use and does not replace professional medical judgment. Always consult the most current prescribing information, local protocols, and relevant literature before making therapeutic decisions.
