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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term relief of mild to moderate pain.
## Primary Indications
* Dysmenorrhea
* Mild to moderate pain (e.g., headache, dental pain, muscle pain)
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed.
* **Dysmenorrhea:** 500 mg orally every 6 hours as needed, starting at the onset of pain and bleeding.
* **Maximum daily dose:** 1500 mg orally.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to limited data and potential risks. Specific pediatric dosing is not well-established and should be determined by a qualified prescriber.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dosage adjustments may be necessary based on the degree of impairment.
* **Hepatic Impairment:** Use with caution. Dosage adjustments may be necessary based on the degree of impairment.
## 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.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, flatulence.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity; cardiovascular thrombotic events; hypersensitivity reactions; exacerbation of asthma; hepatotoxicity; blood dyscrasias.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of gastrointestinal bleeding.
* **Diuretics and Antihypertensives:** May reduce antihypertensive effect and increase risk of renal toxicity.
* **Lithium and Methotrexate:** Mefenamic acid can increase serum levels of these drugs, leading to toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in patients with pre-existing renal disease or those taking other nephrotoxic agents.
* Monitor liver function tests if symptoms suggest hepatotoxicity.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to its short half-life, it is typically used for short-term pain management.
* Avoid concomitant use with other NSAIDs to reduce the risk of adverse effects.
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*Please verify this information with the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
