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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.
## Primary Indications
* Pain, including menstrual pain (dysmenorrhea)
* Pain associated with dental procedures
* Rheumatoid arthritis (less common indication)
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg initially, followed by 250 mg every 6 hours as needed.
* Maximum daily dose: 1250 mg.
* Duration of therapy should be limited to 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age. Limited data is available for pediatric use.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution should be exercised. Mefenamic acid should be used with caution in patients with pre-existing renal or hepatic disease.
## 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.
* Inflammatory bowel disease.
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include:
* Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation.
* Central Nervous System: Dizziness, headache, drowsiness.
* Other: Rash, tinnitus.
Serious adverse effects may include:
* Gastrointestinal bleeding, ulceration, perforation.
* Cardiovascular thrombotic events (MI, stroke).
* Renal and hepatic toxicity.
* Hypersensitivity reactions.
* Hematologic abnormalities.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs and Salicylates:** Increased risk of gastrointestinal toxicity.
* **Diuretics and Antihypertensives:** May reduce their efficacy and increase risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor for signs and symptoms of cardiovascular events.
* Assess renal and hepatic function with long-term use.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest possible duration.
* Avoid concurrent use with other NSAIDs.
* Mefenamic acid should not be used for more than 7 days due to potential for renal toxicity.
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*Please verify this information with the most current prescribing information and local protocols.*
