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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) of the fenamate class. It possesses analgesic and anti-inflammatory properties.
## Primary Indications
* Short-term management of mild to moderate pain, including dysmenorrhea and headache.
* Relief of inflammatory and analgesic conditions.
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg every 6 hours as needed. Doses should not exceed 7 days of continuous use.
* **Maximum Daily Dose:** 1500 mg per day for short-term use.
## Pediatric Dosing
* **Pain/Inflammation:** 6.5 mg/kg every 6 hours as needed.
* **Maximum Daily Dose:** Not established for pediatric use, but typically limited to a maximum of 500 mg per day, similar to adult short-term limits.
* **Note:** Mefenamic acid is generally not recommended for children under 14 years of age unless specifically indicated and prescribed under strict medical supervision due to potential risks.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment, though specific guidelines are not well-established.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe hepatic impairment, though specific guidelines are not well-established.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of bronchospasm, urticaria, or allergic-type reactions after taking 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.
* Severe heart failure.
* Late pregnancy (third trimester).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal dysfunction; hepatotoxicity; cardiovascular thrombotic events; hypersensitivity reactions; bronchospasm; 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.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of gastrointestinal bleeding.
* **Lithium:** Mefenamic acid can increase lithium levels, potentially leading to toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Diuretics and Antihypertensives:** NSAIDs can reduce their efficacy and increase the risk of renal impairment.
## Monitoring
* **Gastrointestinal:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis, abdominal pain).
* **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic Function:** Monitor liver function tests (ALT, AST), especially with prolonged use or in patients with liver disease.
* **Blood Pressure:** Monitor blood pressure, as NSAIDs can cause hypertension.
* **Signs of Hypersensitivity:** Monitor for rash, swelling, or breathing difficulties.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid concurrent use with other NSAIDs or aspirin unless specifically indicated and supervised.
* Consider gastroprotective agents (e.g., proton pump inhibitors) in patients at high risk for gastrointestinal events.
* Discontinue immediately if any signs of serious adverse effects occur.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for any questions regarding medications.*
