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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.
## Primary Indications
* Pain associated with osteoarthritis and rheumatoid arthritis.
* Dysmenorrhea (menstrual pain).
* Mild to moderate pain.
## Adult Dosing
* **Pain:** 500 mg every 4 to 6 hours as needed. Do not exceed 1500 mg in any 24-hour period for short-term use.
* **Dysmenorrhea:** 500 mg every 4 to 6 hours as needed, starting at the onset of pain and bleeding.
## Pediatric Dosing
* Mefenamic acid is generally not recommended for use in children under 14 years of age.
* For children 14 years and older, use adult dosing.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary. Data on specific dose adjustments is limited.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary. Data on specific dose adjustments is limited.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria induced by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or a history of GI bleeding, ulceration, or perforation.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, and headache. Serious adverse effects include GI bleeding, perforation, ulceration, cardiovascular thrombotic events, renal and hepatic toxicity, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors, ARBs, diuretics:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI bleeding:** Monitor for signs and symptoms (e.g., black, tarry stools, hematemesis).
* **Renal function:** Monitor BUN and creatinine, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Hepatic function:** Monitor LFTs, especially in patients with pre-existing hepatic disease.
* **Blood pressure:** NSAIDs can cause or exacerbate hypertension.
* **Cardiovascular risk:** Assess and manage cardiovascular risk factors.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Limit duration of use to the shortest effective period to minimize risks.
* Due to the risk of GI bleeding, it is generally not recommended for long-term use.
* Consider alternative analgesics for patients with a history of peptic ulcer disease or GI bleeding.
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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 any treatment decisions.
