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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, particularly dysmenorrhea.
## Primary Indications
* Pain, including pain associated with menstruation (dysmenorrhea).
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Treatment should not exceed 7 days.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of bleeding and associated pain.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in children under 14 years of age due to a lack of established safety and efficacy.
## Dose Adjustments
No specific dose adjustments are recommended for renal or hepatic impairment, but caution is advised due to potential for exacerbation of existing conditions. Elderly patients may be at increased risk for adverse effects.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe heart failure, renal impairment, or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dizziness, headache, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal impairment; cardiovascular thrombotic events (MI, stroke); hypersensitivity reactions; hepatic dysfunction; 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.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of gastrointestinal adverse effects.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding and ulceration.
* Assess renal and hepatic function, especially in patients with pre-existing conditions or those on long-term therapy.
* Monitor blood pressure, particularly when used with antihypertensives.
* Evaluate for signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use with other NSAIDs.
* Discontinue immediately if signs of rash, allergic reaction, or gastrointestinal bleeding occur.
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*Please verify the current prescribing information for detailed dosing, contraindications, interactions, and warnings.*
