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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term relief of mild to moderate pain.
## Primary Indications
* Pain, including menstrual pain (dysmenorrhea)
* Rheumatic diseases
## Adult Dosing
* **Initial dose:** 500 mg.
* **Subsequent doses:** 250 mg every 6 hours as needed.
* **Maximum duration:** Typically limited to 7 days.
* **Maximum daily dose:** 1500 mg.
## Pediatric Dosing
* Generally not recommended for children under 14 years of age, but specific pediatric dosing is not well-established. If used, it should be under strict medical supervision.
## Dose Adjustments
* **Renal impairment:** Use with caution. Reduced doses may be considered, but specific guidelines are lacking.
* **Hepatic impairment:** Use with caution. Reduced doses may be considered, but specific guidelines are lacking.
## 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.
* Inflammatory bowel disease.
* Severe renal, hepatic, or cardiac impairment.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including acute kidney injury); cardiovascular thrombotic events; hepatic impairment; hypersensitivity reactions; hematologic effects.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** Reduced efficacy of mefenamic acid and increased risk of adverse effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **GI symptoms:** Assess for signs of bleeding or ulceration.
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic medications.
* **Hepatic function:** Monitor liver enzymes if prolonged use or signs of hepatic dysfunction.
* **Blood pressure:** NSAIDs can cause new onset hypertension or worsen existing hypertension.
## Clinical Pearls
* Mefenamic acid is generally intended for short-term use only due to the risk of serious adverse effects, particularly GI bleeding and renal toxicity.
* Administer with food or milk to minimize GI upset.
* Avoid concurrent use with other NSAIDs or aspirin.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
