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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the anthranilic acid derivative class. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Short-term management of mild to moderate pain, including menstrual pain (dysmenorrhea).
* Relief of fever.
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg. Treatment duration typically should not exceed 7 days.
* **Fever:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg. Treatment duration typically should not exceed 3 days.
## Pediatric Dosing
Mefenamic acid is **not recommended** for use in children under 14 years of age due to limited data on safety and efficacy. Some sources may suggest a dose of 6.5 mg/kg every 6 hours, but this should be used with extreme caution and only under strict medical supervision, if at all.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Data is limited, but dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Data is limited, but dose reduction may be necessary in severe impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of asthma, 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 (GI) bleeding or history of recurrent GI bleeding.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis); cardiovascular thrombotic events (MI, stroke); hypersensitivity reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis); hepatic dysfunction.
## 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 toxicity and potential for decreased cardioprotective effect of low-dose aspirin.
* **Diuretics and Antihypertensives:** May reduce diuretic and antihypertensive efficacy; increased risk of renal toxicity.
* **Lithium, Methotrexate:** Increased serum levels and 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 hepatic function (LFTs) if therapy is prolonged or in patients with hepatic impairment.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Mefenamic acid is generally intended for short-term use.
* Administer with food or milk to minimize GI upset.
* Avoid concomitant use with other NSAIDs.
* Should be used at the lowest effective dose for the shortest duration necessary.
**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for definitive patient management decisions.
