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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
* Pain relief (mild to moderate)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain.
Maximum daily dose: 1500 mg. Treatment should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally **not recommended** for use in pediatric patients under 14 years of age due to lack of established efficacy and safety.
## Dose Adjustments
No specific dose adjustments are recommended for renal or hepatic impairment, but caution is advised. Mefenamic acid is generally **contraindicated** in severe renal or hepatic impairment.
## 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.
* Inflammatory bowel disease.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, abdominal pain, and headache. Serious adverse effects can include gastrointestinal bleeding, perforation, ulcers, cardiovascular events, renal toxicity, and hypersensitivity reactions.
## 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 potential for additive effects.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor for signs of cardiovascular events (e.g., chest pain, shortness of breath).
* Monitor renal function, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Due to the risk of gastrointestinal adverse effects, mefenamic acid should be taken with food or milk.
* The duration of therapy should be limited to the shortest effective period, not exceeding 7 days for pain relief.
* Avoid concomitant use with other NSAIDs.
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*Please verify the current prescribing information for the most up-to-date recommendations.*
