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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the fenamate class. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Short-term management of mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, initiated at the onset of pain or bleeding.
* **Maximum:** Do not exceed 1500 mg in a 24-hour period. Treatment duration typically should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to limited data and potential for adverse effects. Dosing in pediatric patients, if considered, would be based on weight and require careful clinical judgment and close monitoring, often with a lower maximum daily dose than adults. Specific established pediatric dosing is not widely available.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment. However, caution is advised in patients with pre-existing renal or hepatic disease due to the potential for NSAID-related toxicity.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of aspirin-induced asthma, urticaria, or allergic rhinitis.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe renal or hepatic impairment.
* Severe heart failure.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, gastritis, peptic ulceration, GI bleeding.
* **Central Nervous System:** Dizziness, headache, drowsiness.
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure (with prolonged use or in susceptible individuals).
* **Hematologic:** Anemia, leukopenia.
* **Other:** Rash, pruritus, 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 and Aspirin:** Increased risk of GI toxicity and other adverse effects.
* **Diuretics and Antihypertensives:** May reduce their efficacy and increase the risk of nephrotoxicity.
* **Lithium and Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding or ulceration.
* Assess for renal function (e.g., BUN, creatinine) with prolonged use or in patients with risk factors.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Due to its short duration of action, it is typically dosed every 6 hours.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Not a first-line agent for chronic pain or inflammatory conditions.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and comprehensive drug information.*
