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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of mild to moderate pain, including menstrual pain.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, typically started at the onset of pain and bleeding.
* **Maximum dose:** 1250 mg in a 24-hour period. Duration of therapy should generally not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is not recommended for use in children under 14 years of age.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dosage adjustments may be necessary, but specific guidelines are not well-established.
* **Hepatic Impairment:** Use with caution. Dosage adjustments may be necessary, but specific guidelines are not well-established.
## 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 recurrent gastrointestinal bleeding.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, hypertension, renal failure, hepatic failure, severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis), hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **Other NSAIDs / Aspirin:** Increased risk of adverse effects, particularly gastrointestinal.
* **Lithium:** Increased lithium levels and potential toxicity.
* **Methotrexate:** Increased methotrexate levels and potential toxicity.
* **Diuretics and Antihypertensives:** May reduce the efficacy of these drugs and increase the risk of renal damage.
## Monitoring
* **GI Symptoms:** Monitor for signs and symptoms of gastrointestinal bleeding.
* **Renal Function:** Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic Function:** Monitor hepatic function, especially in patients with pre-existing liver disease or those at risk.
* **Blood Pressure:** Monitor blood pressure.
## Clinical Pearls
* Mefenamic acid is generally intended for short-term use only.
* Administer with food or milk to reduce gastrointestinal upset.
* Due to potential adverse effects, it is crucial to weigh the benefits against the risks, especially in patients with cardiovascular disease, renal impairment, or a history of GI issues.
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*Please verify the current prescribing information for the most up-to-date and complete drug details.*
