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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. It is also used for the treatment of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Not to exceed 3 days of treatment for pain.
* **Primary Dysmenorrhea:** 500 mg every 6 hours starting at the onset of pain and bleeding and continuing for the duration of the symptoms, typically no more than 3 days.
## Pediatric Dosing
Mefenamic acid is not generally recommended for children under 14 years of age due to lack of established efficacy and safety data.
## Dose Adjustments
No dose adjustments are typically required for renal or hepatic impairment, however, caution is advised and the lowest effective dose should be used. Mefenamic acid is generally not recommended for patients with severe renal or hepatic impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of bronchospasm, asthma, or allergic rhinitis precipitated by aspirin or other NSAIDs.
* Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis).
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, abdominal pain, headache, and rash. Serious adverse effects can include gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic toxicity, cardiovascular thrombotic events, and severe skin reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics and Antihypertensives:** May reduce the efficacy of diuretics and antihypertensives; increased risk of renal toxicity.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate levels and risk of toxicity.
* **Other NSAIDs and Aspirin:** Increased risk of adverse effects, particularly gastrointestinal bleeding.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding or ulceration.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy.
* Monitor blood pressure, as NSAIDs can cause or exacerbate hypertension.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Duration of use should be limited to the shortest effective period, generally not exceeding 7 days for all indications combined.
* Due to the risk of diarrhea, it is important to monitor for dehydration.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.
