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# Mefenamic Acid (meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term management of mild to moderate pain. It is also used for primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg initially, followed by 250 mg every 6 hours as needed.
* **Maximum:** Do not exceed 1500 mg in a 24-hour period. Duration of use typically limited to 7 days.
## Pediatric Dosing
* **Children 12 years and older:** Dosing is the same as adults (500 mg every 6 hours as needed for pain; 500 mg initially, then 250 mg every 6 hours for dysmenorrhea).
* **Children younger than 12 years:** Use is generally not recommended due to lack of established safety and efficacy.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dosage adjustments are not well-defined, but reduced doses may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. Reduced doses may be considered.
## 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.
* Peptic ulcer disease.
* Severe renal or hepatic impairment.
* Severe heart failure.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, abdominal pain, constipation, rash.
Serious: Gastrointestinal bleeding, ulceration, perforation; myocardial infarction, stroke; renal failure; hepatic failure; hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics and antihypertensives:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase serum lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
* **Other NSAIDs and aspirin:** Increased risk of gastrointestinal adverse effects and reduced antiplatelet effect of aspirin.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function (LFTs).
* Blood pressure.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* It is intended for short-term use only.
* Due to potential for diarrhea, it is important to monitor hydration status, especially in children and the elderly.
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*This information is intended for clinical use and does not replace the need to consult the official prescribing information and local protocols.*
