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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.
* Primary dysmenorrhea.
* Mild to moderate pain of other origins.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours, starting at the onset of pain and bleeding, and continuing for up to 3 days.
* **Maximum:** Do not exceed 1000 mg as a single dose or 4000 mg per day.
## Pediatric Dosing
* **Pain:** Generally not recommended for children under 14 years of age. Limited data exists for younger children. Consult specific pediatric guidelines or a pediatrician.
## Dose Adjustments
* No dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Mefenamic acid should be used with caution in patients with pre-existing renal or hepatic disease due to the risk of drug-induced organ damage.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; 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.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** Potential for diminished antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding or perforation (e.g., melena, hematemesis, severe abdominal pain).
* Assess for signs of cardiovascular events.
* Monitor renal and hepatic function, particularly with prolonged use or in patients with pre-existing organ disease.
* Monitor blood pressure, especially in patients taking antihypertensive medications.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Limit duration of use to typically 7 days for pain relief due to potential for serious adverse effects.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and complete details.*
