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# Mefenamic Acid
## Overview
Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) of the fenamate class.
## Primary Indications
* Short-term management of mild to moderate pain, including menstrual pain.
* Management of inflammatory conditions.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Inflammation:** 500 mg three times daily.
* **Maximum:** Not to exceed 1000 mg per dose or 4000 mg per day.
## Pediatric Dosing
* **Age:** Typically not recommended for children under 14 years of age. Limited data for pediatric use.
## Dose Adjustments
* **Renal Impairment:** Use with caution; dose reduction may be necessary depending on severity.
* **Hepatic Impairment:** Use with caution; dose reduction may be necessary depending on severity.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of gastrointestinal (GI) bleeding or perforation related to prior NSAID use.
* Active peptic ulceration or history of recurrent peptic ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, headache, dizziness.
* **Serious:** GI bleeding, ulceration, perforation; renal toxicity (including acute kidney injury); cardiovascular thrombotic events; hepatic dysfunction; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## 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 GI adverse effects and renal toxicity.
* **Diuretics:** Reduced diuretic efficacy; increased risk of renal impairment.
* **ACE inhibitors and ARBs:** Increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate 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 on concomitant nephrotoxic agents.
* Monitor liver function tests.
* Assess for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Limit duration of use to the shortest effective period due to potential for serious GI and cardiovascular adverse effects.
* Avoid in patients with a history of asthma exacerbated by NSAIDs.
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**Disclaimer:** This information is intended for clinical professionals and does not replace full prescribing information. Always verify current prescribing information and consult with a healthcare provider for specific patient care decisions.
