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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term symptomatic relief of mild to moderate pain. It is a member of the fenamate class.
## Primary Indications
* Symptomatic relief of mild to moderate pain, including menstrual pain (dysmenorrhea).
## Adult Dosing
* **Initial dose:** 500 mg every 6 hours as needed.
* **Maximum dose:** Do not exceed 1500 mg in a 24-hour period.
* **Duration:** Typically for short-term use, not exceeding 7 days for pain.
## Pediatric Dosing
* **Established pediatric dosing is not readily available and its use in children is generally limited.** Consult specific pediatric guidelines or a pediatrician for guidance. Some sources suggest 6.5 mg/kg/dose every 6 hours for children over 6 months of age.
## Dose Adjustments
* **Renal impairment:** Use with caution. Data on dose adjustment is limited, but reduced doses may be considered in severe impairment.
* **Hepatic impairment:** Use with caution. Data on dose adjustment is limited.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* 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 history of recurrent gastrointestinal bleeding.
* Severe heart failure, renal impairment, or hepatic impairment.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, rash, dizziness.
* **Serious:**
* **Gastrointestinal:** Bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and heart failure.
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure.
* **Hepatic:** Elevated liver enzymes, jaundice, hepatitis.
* **Hematologic:** Anemia, leukopenia, thrombocytopenia.
* **Hypersensitivity:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** Increased risk of GI toxicity.
* **Corticosteroids:** Increased risk of GI bleeding.
* **SSRIs and SNRIs:** Increased risk of GI bleeding.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate levels and toxicity.
* **Diuretics and antihypertensives:** May reduce their efficacy and increase risk of renal impairment.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor for cardiovascular risk factors and signs of heart failure.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Mefenamic acid is generally recommended for short-term use only due to the risk of adverse effects, particularly gastrointestinal issues.
* Administer with food or milk to minimize gastric irritation.
* Avoid concomitant use with other NSAIDs.
* Consider the risks and benefits carefully, especially in elderly patients or those with cardiovascular, renal, or hepatic disease.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete details. Local protocols may influence specific dosing and management strategies.*
