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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of mild to moderate pain, particularly in primary dysmenorrhea. It is also used for fever.
## Primary Indications
* Pain (mild to moderate)
* Primary dysmenorrhea
* Fever
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg every 6 hours as needed. Treatment should not exceed 7 days.
* **Fever:** 500 mg every 6 hours as needed.
## Pediatric Dosing
* **Pain/Fever:** Generally not recommended for children under 14 years old due to limited safety and efficacy data. Some sources suggest dosing based on weight (e.g., 6.5 mg/kg every 6 hours), but this is not widely established. **Consult specific pediatric guidelines or specialist advice.**
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose adjustments may be necessary, especially in severe impairment.
* **Hepatic Impairment:** Use with caution. Dose adjustments may be necessary, especially in severe impairment.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* History of bronchospasm, asthma, rhinitis, or urticaria induced by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or a history of GI bleeding/ulceration.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common:
* GI disturbances (diarrhea, nausea, vomiting, abdominal pain, constipation)
* Headache
* Dizziness
* Drowsiness
Serious:
* GI ulceration, bleeding, perforation
* Cardiovascular thrombotic events (myocardial infarction, stroke)
* Renal toxicity (interstitial nephritis, papillary necrosis, renal failure)
* Hepatic toxicity (hepatitis, jaundice)
* Hypersensitivity reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis)
* Anemia
* Fluid retention and edema
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of GI adverse effects and potential for additive pharmacodynamic effects.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Ciclosporin, Tacrolimus:** Increased risk of nephrotoxicity.
## Monitoring
* **GI symptoms:** Monitor for signs and symptoms of GI bleeding or ulceration.
* **Renal function:** Monitor BUN, creatinine, and urine output, especially in patients with risk factors for renal impairment.
* **Hepatic function:** Monitor LFTs (ALT, AST), especially with prolonged use or in patients with pre-existing liver disease.
* **Blood pressure:** Monitor for potential increase in blood pressure.
* **Signs of hypersensitivity:** Monitor for rash, urticaria, or signs of anaphylaxis.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Limit duration of use to the shortest effective period, generally not exceeding 7 days for pain or dysmenorrhea.
* Consider risk factors for GI bleeding (e.g., history of ulcers, concomitant corticosteroid or anticoagulant use) before initiating therapy.
* Mefenamic acid is generally not considered a first-line agent for chronic inflammatory conditions compared to other NSAIDs.
* There is no established antidote for mefenamic acid overdose. Management is supportive.
***
**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current official prescribing information and relevant guidelines before making any clinical decisions. Dosing and recommendations may vary based on patient-specific factors and local protocols.
