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# Mefenamic Acid
## Overview
Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain. It is also used for the treatment of primary dysmenorrhea.
## Primary Indications
* Pain, mild to moderate (e.g., dental pain, post-operative pain, menstrual pain)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 to 8 hours as needed. Do not exceed 1500 mg in the first 24 hours or 1000 mg in any 24-hour period thereafter.
* **Primary Dysmenorrhea:** 500 mg every 6 to 8 hours as needed, starting at the onset of pain and bleeding and continuing for the duration of symptoms. Do not exceed 1500 mg in the first 24 hours or 1000 mg in any 24-hour period thereafter.
* Treatment should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age due to lack of established safety and efficacy data. Dosing for pediatric patients, if deemed necessary, should be determined by a specialist based on individual patient factors and weight.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Reduced doses may be necessary in patients with moderate to severe renal impairment.
* **Hepatic Impairment:** Use with caution. Reduced doses may be necessary in patients with hepatic impairment.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; hypersensitivity reactions; 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.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** Mefenamic acid can reduce their antihypertensive effect and increase the risk of renal impairment.
* **Diuretics:** Reduced diuretic effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor for signs of cardiovascular events.
* Renal and hepatic function should be monitored periodically, especially in patients with pre-existing impairment or those on long-term therapy.
* Monitor for hypersensitivity reactions.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only.
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concomitant use with other NSAIDs.
* Consider risks versus benefits in patients with cardiovascular disease, hypertension, renal or hepatic impairment, or a history of gastrointestinal issues.
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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 the best course of treatment for your specific condition. Please verify the current prescribing information before making any treatment decisions.*
