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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) of the fenamate class. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Short-term management of mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours, usually starting with the onset of pain and continuing for up to 3 days.
Maximum daily dose for adults is typically 1500 mg.
## Pediatric Dosing
Mefenamic acid is generally **not recommended for pediatric use** unless under specialist guidance due to limited data and potential for adverse effects. When used, dosing is typically weight-based, but specific established pediatric guidelines are scarce.
## Dose Adjustments
No specific dose adjustments are generally required for hepatic or renal impairment, but caution is advised. Use with caution in elderly patients.
## 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 (GI) bleeding or history of recurrent GI ulceration/bleeding.
* Severe renal, hepatic, or cardiac impairment.
* Pregnancy (third trimester).
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, and rash. Serious adverse effects include GI bleeding, ulceration, perforation, cardiovascular thrombotic events, renal toxicity, hepatic toxicity, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs and Aspirin:** Increased risk of adverse effects, particularly GI bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Diuretics:** May reduce diuretic effect and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those at risk.
* Monitor liver function tests (ALT, AST) especially with prolonged use.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Should be taken with food or milk to minimize GI upset.
* Avoid concomitant use with other NSAIDs.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* The drug has a relatively short half-life, requiring frequent dosing for continuous effect.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional guidelines before making clinical decisions.*
