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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
* Pain associated with osteoarthritis and rheumatoid arthritis.
* Menstrual pain (dysmenorrhea).
* Mild to moderate pain from other causes.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Maximum daily dose is 1500 mg.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding. Maximum daily dose is 1500 mg.
* Treatment duration should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is not generally recommended for children under 14 years of age due to limited data and potential for adverse effects. For children 14 years and older, use adult dosing.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Use the lowest effective dose for the shortest duration necessary.
## 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 (active or history of).
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; cardiovascular events (MI, stroke); hypersensitivity reactions; hepatic dysfunction; Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs or Salicylates:** Increased risk of adverse effects, particularly gastrointestinal.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those at risk.
* Monitor blood pressure, especially in patients with hypertension.
* 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 is typically dosed every 6 hours.
* It is generally used for short-term pain management; long-term use is not recommended.
* Avoid concurrent use with other NSAIDs.
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*Disclaimer: This information is intended for healthcare professionals and does not replace a thorough review of the current prescribing information or consultation with a physician. Always verify the latest drug information before making clinical decisions.*
