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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) that functions as a prostaglandin synthetase inhibitor.
## Primary Indications
* Short-term management of mild to moderate pain.
* Management of primary dysmenorrhea.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, typically starting with the onset of pain and bleeding.
The maximum daily dose for adults is 1500 mg. Treatment duration should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to limited data and potential for adverse effects. For specific pediatric indications and dosing, consult specialized pediatric drug information resources or local protocols.
## Dose Adjustments
No specific dose adjustments are routinely recommended for renal or hepatic impairment. However, caution is advised, and dose reduction may be considered in patients with severe impairment.
## Contraindications
* Known 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 (IBD).
* Severe heart failure.
* Renal or hepatic failure.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dizziness, and headache. More serious adverse effects include:
* **Gastrointestinal:** Bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and new or worsened hypertension.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Liver enzyme elevations, hepatitis.
* **Hematologic:** Anemia, leukopenia.
* **Dermatologic:** Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly gastrointestinal.
* **Diuretics and antihypertensives:** May reduce their efficacy and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum concentrations and potential for toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding.
* Monitor renal function, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* Monitor blood pressure, particularly in patients with hypertension.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to its short half-life, it is typically dosed every 6 hours.
* It is generally reserved for short-term use due to the potential for serious adverse effects with prolonged administration.
* The duration of use should be limited to the shortest effective period.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
