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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term management of mild to moderate pain.
## Primary Indications
* Short-term treatment of pain, including menstrual pain (dysmenorrhea), dental pain, and headache.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg. Therapy should not exceed 7 days.
## Pediatric Dosing
* Mefenamic acid is **not recommended** for use in children under 14 years of age.
## Dose Adjustments
* **Renal Impairment:** Use with caution. No specific dose adjustment guidelines are established, but may require reduced frequency or dose.
* **Hepatic Impairment:** Use with caution. No specific dose adjustment guidelines are established, but may require reduced frequency or dose.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* History of NSAID-induced bronchospasm, urticaria, or allergic rhinitis.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe renal or hepatic impairment.
* Severe heart failure.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, dizziness, headache, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis, renal failure); cardiovascular thrombotic events (MI, stroke); hypersensitivity reactions; hepatic toxicity; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic and antihypertensive effects; increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **Renal function:** Monitor baseline and periodically during therapy, especially in patients with pre-existing renal disease or at risk for renal toxicity.
* **Hepatic function:** Monitor baseline and periodically during therapy.
* **Gastrointestinal symptoms:** Assess for signs and symptoms of GI bleeding or ulceration.
* **Blood pressure:** Monitor blood pressure, especially in patients taking antihypertensive medications.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to the risk of serious adverse effects, it should be used at the lowest effective dose for the shortest duration necessary.
* The maximum duration of therapy is typically 7 days.
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*Please verify this information with the most current prescribing information and relevant clinical guidelines before patient use.*
