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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term management of mild to moderate pain. It is also used for the treatment of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain and bleeding, and continuing for the duration of the symptoms.
* **Maximum duration:** Typically recommended for a maximum of 7 days of treatment.
## Pediatric Dosing
* **Age:** Generally recommended for patients 14 years of age and older.
* **Dosing:** Similar to adults: 500 mg every 6 hours as needed for pain or dysmenorrhea.
* **Note:** Safety and efficacy in younger children have not been established.
## Dose Adjustments
* **Renal Impairment:** Use with caution; dose reduction may be necessary. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary. Avoid in severe hepatic impairment.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* History of gastrointestinal bleeding or perforation related to previous NSAID use.
* Active peptic ulceration or recurrent peptic ulceration.
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and headache. Serious adverse effects can include gastrointestinal bleeding, ulceration, perforation, renal toxicity, cardiovascular thrombotic events, myocardial infarction, stroke, hypertension, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of gastrointestinal bleeding.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Diuretics and Antihypertensives:** May decrease efficacy and increase risk of renal toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in patients with pre-existing renal disease or those receiving concomitant nephrotoxic agents.
* Monitor blood pressure.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to its potential for gastrointestinal side effects, it should be used for the shortest duration necessary.
* Consider alternative analgesics if symptoms persist beyond 7 days of treatment.
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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 initiating or modifying therapy. Dosing and recommendations may vary based on individual patient factors and local protocols.
