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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, particularly menstrual pain.
## Primary Indications
* Pain (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg every 6 hours as needed. Maximum duration of use is typically 7 days. Do not exceed 1500 mg per day.
## Pediatric Dosing
* **Pain/Dysmenorrhea:** Dosing is not well-established in pediatric patients. Use with caution and at the lowest effective dose, typically for children 12 years and older, at the adult dose.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose adjustments are not well-defined, but reduced doses may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. Dose adjustments are not well-defined, but reduced doses may be considered in severe impairment.
## Contraindications
* Known 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.
* Active gastrointestinal bleeding or history of GI bleeding or perforation related to prior NSAID use.
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; hypersensitivity reactions (including anaphylaxis); bronchospasm; 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.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity and other adverse effects.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum concentrations, leading to toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (e.g., BUN, creatinine), especially in patients with pre-existing renal disease or those at risk.
* Liver function (e.g., AST, ALT), especially with prolonged use or in patients with hepatic impairment.
* Blood pressure, especially in patients with hypertension.
* Signs of cardiovascular events.
## Clinical Pearls
* Should be taken with food or milk to minimize gastric upset.
* Recommended for short-term use only (typically not more than 7 days) due to increased risk of serious adverse events with prolonged use.
* The lowest effective dose should be used for the shortest duration necessary.
* Use cautiously in elderly patients due to increased risk of adverse effects, particularly GI bleeding.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines for complete details and to ensure patient safety.*
