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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term management of mild to moderate pain.
## Primary Indications
* Pain management (e.g., dysmenorrhea, dental pain, musculoskeletal pain).
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed.
* **Maximum daily dose:** 1500 mg orally.
* **Duration:** Generally recommended for short-term use (up to 7 days).
## Pediatric Dosing
* Mefenamic acid is **not recommended** for use in children under 14 years of age. Data on safety and efficacy in younger children is limited.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe hepatic impairment.
* **Geriatric Patients:** Use with caution due to increased risk of adverse effects, particularly gastrointestinal bleeding and renal toxicity.
## 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.
* Active gastrointestinal bleeding or ulcer disease.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic failure; cardiovascular thrombotic events; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal toxicity and other adverse effects.
* **ACE inhibitors and ARBs:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Diuretics:** May decrease diuretic effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Particularly with prolonged use or in patients with liver disease.
* **Signs of gastrointestinal bleeding:** Stool guaiac, occult blood in urine.
* **Blood pressure:** NSAIDs can cause fluid retention and elevate blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Limit duration of use to the shortest effective period to reduce the risk of serious adverse effects.
* Consider gastroprotective agents (e.g., PPIs, misoprostol) in patients at high risk for GI complications.
* Discontinue if signs of renal toxicity, hepatic toxicity, or hypersensitivity occur.
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*This information is intended as a quick reference and does not replace the need to consult current prescribing information and professional judgment.*
