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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain. It is also indicated for primary dysmenorrhea.
## Primary Indications
* Pain relief (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed. Do not exceed 7 days of treatment.
* **Primary Dysmenorrhea:** 500 mg orally every 6 hours starting at the onset of pain or bleeding, whichever comes first. Treatment should not exceed 3 days.
## Pediatric Dosing
Mefenamic acid is **not recommended** for use in children under 14 years of age due to lack of established safety and efficacy data.
## Dose Adjustments
No specific dose adjustments are recommended for renal or hepatic impairment. However, caution is advised as NSAIDs can cause renal injury, and hepatic effects have been reported.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or other NSAID administration.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dyspepsia, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions; worsening of asthma in patients with aspirin-sensitive asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum 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 (BUN, creatinine) especially in patients with pre-existing renal disease or those at risk.
* Monitor liver function tests (LFTs) if therapy is prolonged or if signs of hepatic dysfunction arise.
* Monitor blood pressure.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Limit treatment duration to the shortest effective period, generally no more than 7 days for pain and 3 days for dysmenorrhea, to reduce the risk of serious adverse effects.
* Avoid concomitant use with other NSAIDs or aspirin.
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*Please consult the most current prescribing information and local protocols for definitive guidance.*
