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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain. It is also used for the management of primary dysmenorrhea.
## Primary Indications
* **Pain:** Short-term relief of mild to moderate pain, including headache, muscle ache, dental pain, and menstrual pain.
* **Primary Dysmenorrhea:** Management of pain associated with menstruation.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Do not exceed 1500 mg in a 24-hour period.
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding. Do not exceed 1500 mg in a 24-hour period.
* Treatment should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally **not recommended** for use in children under 14 years of age for pain relief due to limited data and the availability of other safer options. For pediatric use in specific indications like closure of patent ductus arteriosus, refer to specialized pediatric guidelines.
## Dose Adjustments
No specific dose adjustments are required for renal or hepatic impairment; however, caution is advised, and the lowest effective dose should be used.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* 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 (GI) bleeding or a history of recurrent GI ulceration/bleeding.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and constipation. More serious adverse effects may include GI bleeding, ulceration, perforation, cardiovascular thrombotic events, renal impairment, hepatic dysfunction, and hypersensitivity reactions.
## 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.
* **ACE inhibitors and Angiotensin II Receptor Blockers (ARBs):** May decrease antihypertensive effect and increase risk of renal impairment.
* **Diuretics:** May decrease diuretic effect and increase risk of renal impairment.
* **Lithium:** May increase serum lithium levels and risk of toxicity.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor renal function (e.g., BUN, creatinine) in patients with pre-existing renal disease or those at risk.
* Monitor hepatic function (e.g., ALT, AST) in patients with pre-existing hepatic disease or those at risk.
* Monitor for cardiovascular risk factors and signs of thrombotic events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Due to the risk of GI bleeding and cardiovascular events, use the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use with other NSAIDs.
* Discontinue immediately if signs of GI ulceration or bleeding occur.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine what is best for your unique situation. Verify the most current prescribing information before making any treatment decisions.*
