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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term relief of mild to moderate pain. It is a cyclooxygenase (COX) inhibitor.
## Primary Indications
* Pain, including menstrual pain (dysmenorrhea), dental pain, and pain associated with musculoskeletal conditions.
## Adult Dosing
* **Initial Dose:** 500 mg orally every 4 to 6 hours as needed.
* **Maximum Daily Dose:** 1500 mg orally per day.
* Treatment should not exceed 7 days.
## Pediatric Dosing
* Mefenamic acid is generally not recommended for use in children under 14 years of age due to limited data and potential for adverse effects. However, if used, dosing may be based on weight, but specific recommendations are not widely established and often left to local protocol.
## Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised due to potential for adverse effects. Patients with severe impairment should be closely monitored.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* Patients with a history of aspirin-induced asthma, urticaria, or allergic rhinitis.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; hepatic dysfunction; cardiovascular events (MI, stroke); hypersensitivity reactions; 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.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly gastrointestinal.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Monitor renal function (BUN, creatinine) and liver function tests (LFTs), especially in patients with pre-existing impairment or those on long-term therapy.
* Monitor blood pressure.
* Assess for signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Short-term use is recommended due to increased risk of serious adverse events with prolonged use.
* Avoid concurrent use with other NSAIDs.
* Consider risks versus benefits in patients with cardiovascular disease, hypertension, heart failure, or dehydration.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the appropriateness of any medication for your specific condition. Verify the current prescribing information and local protocols before administering any medication.*
