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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 is also used for the management of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg. Treatment should not exceed 7 days.
* **Primary Dysmenorrhea:** 500 mg every 6 hours, starting at the onset of pain or bleeding and continuing for the duration of symptoms, up to 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age due to limited data and potential for adverse effects. Some sources suggest **125 mg every 6 hours for children 6-12 years old** for short-term use if deemed necessary by a prescriber, but this dosing is not well-established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary, particularly in severe impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after 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:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal and hepatic toxicity; hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs or Salicylates:** Increased risk of adverse effects, including gastrointestinal bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine).
* Hepatic function (ALT, AST).
* Blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Limit duration of use to the shortest effective period to minimize risks.
* Avoid in patients with a history of peptic ulcer disease or significant cardiovascular risk factors.
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*Please verify current prescribing information and institutional protocols for definitive guidance.*
