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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 management of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain (e.g., dental pain, post-operative pain, musculoskeletal pain)
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg orally every 6 hours, typically started at the onset of pain or bleeding and continued for up to 3 days.
## Pediatric Dosing
Mefenamic acid is **not recommended** for use in children under 14 years of age due to lack of established efficacy and safety.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, however, caution is advised in patients with severe impairment. The risks and benefits should be carefully considered.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* Patients with a history of gastrointestinal (GI) bleeding or perforation related to previous NSAID use.
* Active peptic ulceration or a history of recurrent peptic ulceration/hemorrhage.
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, constipation, rash.
* **Serious:** GI bleeding, ulceration, perforation; cardiovascular thrombotic events; renal toxicity; hepatic toxicity; hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI adverse effects.
* **Other NSAIDs (including aspirin):** Increased risk of GI toxicity and other adverse effects.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (especially in patients with pre-existing renal disease or those taking diuretics/ACE inhibitors).
* Hepatic function (especially with prolonged use or in patients with liver disease).
* Blood pressure.
## Clinical Pearls
* Mefenamic acid should be used for the shortest duration necessary to control symptoms.
* Administer with food or milk to minimize GI upset.
* Maximum daily dose is 1500 mg. Doses exceeding 1500 mg daily are not recommended.
* Use with caution in the elderly, as they are more susceptible to adverse effects, particularly GI bleeding.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. Local protocols may dictate specific dosing or management.
