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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term management of mild to moderate pain and for the treatment of primary dysmenorrhea.
## Primary Indications
* Mild to moderate pain
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg initially, followed by 250 mg every 6 hours as needed.
* **Maximum daily dose:** 1250 mg for intermittent use, 750 mg for chronic use (though typically limited to 7 days).
## Pediatric Dosing
Mefenamic acid is **not generally recommended for children under 14 years of age** due to limited data and potential for adverse effects. If used, doses are typically based on weight, but specific guidelines can vary and should be determined by a healthcare professional.
## Dose Adjustments
No dose adjustments are typically required for renal or hepatic impairment, but caution is advised in severe dysfunction due to potential for NSAID-related toxicity.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or history of GI bleeding/perforation with prior NSAID use.
* Severe heart failure.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, abdominal pain, constipation, dyspepsia, rash, dizziness, headache.
Serious: GI bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic dysfunction; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium, methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs/Salicylates:** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN) especially in patients with risk factors.
* Liver function tests (LFTs) if symptoms of hepatic dysfunction arise.
* Blood pressure.
## Clinical Pearls
* Limit duration of use to the shortest effective period.
* Administer with food or milk to reduce GI upset.
* Diarrhea is a common and dose-limiting side effect. Discontinue if severe diarrhea occurs.
* Use with caution in elderly patients and those with pre-existing cardiovascular, renal, or hepatic disease.
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*Disclaimer: This information is intended for educational purposes and does not substitute professional medical advice. Always verify current prescribing information with the latest official drug monographs or regulatory agency websites.*
