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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 menstrual pain.
## Primary Indications
* Pain relief, especially dysmenorrhea.
* Rheumatoid arthritis and osteoarthritis (less common due to safety profile).
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Do not exceed 7 days of continuous use.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding.
* **Maximum Daily Dose:** 1500 mg.
## Pediatric Dosing
* Mefenamic acid is generally not recommended for children under 14 years of age due to limited data and potential risks.
## Dose Adjustments
* No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised. Due to potential renal toxicity associated with NSAIDs, use with caution and consider reduced doses if necessary.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of NSAID-induced bronchospasm, urticaria, or allergic-type reactions.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe renal or hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, abdominal pain, headache, dizziness.
Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal toxicity; hepatic dysfunction; hypersensitivity reactions; bronchospasm.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs and SNRIs:** Increased risk of GI bleeding.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics and Antihypertensives:** May reduce efficacy and increase risk of renal toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Assess for renal function (BUN, creatinine) and hepatic function (LFTs), especially with prolonged use or in at-risk patients.
* Monitor blood pressure.
* Observe for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Limit duration of use to 7 days maximum for acute pain due to increased risk of adverse effects with prolonged exposure.
* Consider NSAID-associated risks (GI, cardiovascular, renal) in all patients.
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*Please verify current prescribing information for the most up-to-date recommendations.*
