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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 and for the management of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain (e.g., dental pain, musculoskeletal pain)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding.
* **Maximum dose:** Do not exceed 4000 mg per day. Treatment should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally **not recommended for use in children under 14 years of age** due to a higher incidence of adverse effects, particularly renal toxicity. If used, dosing should be determined by a healthcare professional based on weight and clinical judgment, with careful monitoring.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Reduced doses may be necessary. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Reduced doses may be necessary. Avoid in severe hepatic impairment.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, 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 (active or history).
* Renal or hepatic failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis, renal failure); hepatic toxicity; 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/Aspirin:** Increased risk of gastrointestinal toxicity and renal toxicity.
* **ACE inhibitors, Angiotensin II Receptor Blockers (ARBs), Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Monitor liver enzymes, especially in patients with pre-existing liver disease or those at risk.
* **Gastrointestinal symptoms:** Assess for signs and symptoms of bleeding or ulceration.
* **Blood pressure:** Monitor for potential increase.
## Clinical Pearls
* Administer with food or milk to reduce gastrointestinal upset.
* Limit duration of use to the shortest effective period due to increased risk of adverse events with prolonged use.
* Caution in patients with cardiovascular disease, hypertension, or risk factors for these conditions.
* Discontinue at the first sign of rash, skin reaction, or any other sign of hypersensitivity.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before making any clinical decisions.
