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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain, including menstrual pain.
## Primary Indications
* Pain relief (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding.
Maximum daily dose: 1500 mg. Treatment duration should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age due to safety concerns and lack of established dosing.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment, however, caution is advised. Mefenamic acid is not recommended for patients with severe renal or hepatic impairment.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* 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.
* Inflammatory bowel disease.
* Renal or hepatic failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, flatulence.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic failure; cardiovascular thrombotic events; myocardial infarction; stroke; hypertension; fluid retention; edema; 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.
* **ACE inhibitors, ARBs, beta-blockers:** Decreased antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Decreased diuretic effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs and salicylates:** Increased risk of gastrointestinal adverse effects.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy.
* Monitor blood pressure.
* Assess for signs of hypersensitivity reactions.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to its short half-life, it requires dosing every 6 hours.
* Avoid concurrent use with other NSAIDs.
* Limit use to the shortest duration necessary to control symptoms.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before administering any medication. Dosing and recommendations may vary based on individual patient factors and local protocols.*
