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## Mefenamic Acid
### Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic and anti-inflammatory properties. It is primarily used for short-term management of pain.
### Primary Indications
* Short-term management of mild to moderate pain, including pain associated with menstruation.
### Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Do not exceed 1000 mg as a single dose or 4000 mg per day. Therapy should not exceed 7 days.
### Pediatric Dosing
* **Pain:** Mefenamic acid is generally **not recommended** for children under 14 years of age due to lack of established safety and efficacy data, and the availability of safer alternatives. If used, dosing is typically based on weight and is highly variable and requires careful consideration. Consultation with a pediatrician or pediatric pharmacist is advised.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Consider dose reduction.
* **Hepatic Impairment:** Use with caution. Consider dose reduction.
### 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.
### Adverse Effects
Common:
* Gastrointestinal (GI) upset (nausea, vomiting, diarrhea, abdominal pain)
* Dizziness
* Headache
Serious:
* GI bleeding, ulceration, and perforation
* Cardiovascular thrombotic events
* Renal toxicity
* Hepatotoxicity
* Serious skin reactions (e.g., Stevens-Johnson syndrome)
* Hematologic effects
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May decrease the cardioprotective effects of low-dose aspirin; potential for additive GI toxicity.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
### Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy.
* Monitor blood pressure.
* Assess pain relief.
### Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize GI upset.
* Limit duration of use to the shortest effective period.
* Due to potential for serious GI effects, it should be used cautiously in elderly patients and those with a history of GI disease.
* Hydration status should be maintained, especially if diarrhea or vomiting occurs.
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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 or a qualified healthcare professional for definitive guidance.*
