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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain and for the treatment of primary dysmenorrhea.
## Primary Indications
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg.
* **Primary dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding, whichever occurs first. Treatment should not exceed 3 days.
## Pediatric Dosing
Mefenamic acid is **not recommended** for children under 14 years of age due to insufficient data on safety and efficacy.
## Dose Adjustments
No specific dose adjustments are recommended for renal or hepatic impairment, but caution is advised. Mefenamic acid is contraindicated in severe renal or hepatic impairment.
## Contraindications
* 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 bleeding or history of recurrent gastrointestinal ulceration or bleeding.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, abdominal pain, and headache. Serious adverse effects include gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, cardiovascular thrombotic events, hypersensitivity reactions, and Stevens-Johnson syndrome.
## 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.
* **Diuretics and antihypertensives:** May reduce antihypertensive effect and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in patients with pre-existing renal disease.
* Monitor hepatic function.
* Assess pain relief and for signs of adverse effects.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* It is generally recommended for short-term use only.
* Due to the risk of diarrhea, patients should be advised to report severe or persistent diarrhea.
* The maximum duration of therapy for pain is typically 7 days.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions. Dosing and indications may vary based on local protocols and individual patient factors.
