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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain, including menstrual pain and pain associated with dental procedures. It functions by inhibiting cyclooxygenase (COX) enzymes, thus reducing prostaglandin synthesis.
## Primary Indications
* Short-term management of mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg initially, followed by 250 mg every 6 hours as needed.
* Maximum daily dose: 1500 mg.
* Duration of use generally limited to 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to limited data and potential for increased risk of adverse effects. For children aged 14 years and older, adult dosing recommendations apply.
## Dose Adjustments
* **Renal Impairment:** Use with caution; may require dose reduction depending on severity.
* **Hepatic Impairment:** Use with caution; may require dose reduction depending on severity.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease (active or history).
* Severe renal or hepatic impairment.
* Severe heart failure.
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and constipation. Serious adverse effects include gastrointestinal bleeding, ulceration, perforation, cardiovascular thrombotic events, renal toxicity, hepatic toxicity, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor renal and hepatic function, especially with prolonged use or in patients with pre-existing impairment.
* Monitor blood pressure, particularly in patients with hypertension.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to potential for CNS effects, patients should exercise caution when driving or operating machinery.
* This drug is generally intended for short-term use only.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete drug information, including indications, contraindications, warnings, precautions, adverse reactions, drug interactions, and dosing. Verify dosages and recommendations with the most up-to-date resources before administration.*
