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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.
## Primary Indications
* Pain management, particularly for dysmenorrhea.
* Relief of mild to moderate pain from other causes.
## Adult Dosing
* **Initial Dose:** 500 mg orally.
* **Subsequent Doses:** 250 mg orally every 6 hours as needed.
* **Maximum Dose:** 750 mg orally for the initial dose, followed by 500 mg every 6 hours. Total daily dose should not exceed 1500 mg. Treatment duration is typically limited to 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.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Data is limited, but dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Data is limited, but dose reduction may be necessary in severe 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.
* Known inflammatory bowel disease.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, constipation, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal toxicity and other adverse effects.
* **Diuretics and Antihypertensives:** NSAIDs can reduce the efficacy of these drugs and increase the risk of renal impairment.
* **Lithium and Methotrexate:** NSAIDs can increase serum concentrations of these drugs, potentially leading to toxicity.
## Monitoring
* **Gastrointestinal:** Monitor for signs and symptoms of bleeding (e.g., melena, hematemesis) and ulceration.
* **Renal Function:** Monitor BUN and creatinine, especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor liver enzymes, especially with prolonged use or in patients with known liver disease.
* **Cardiovascular:** Assess risk factors for cardiovascular events.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only.
* Administer with food or milk to reduce gastrointestinal upset.
* Due to potential for diarrhea, ensure adequate hydration.
* Consider risks of NSAID use (GI bleeding, cardiovascular events, renal toxicity) in all patients, especially the elderly and those with pre-existing conditions.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical judgment. Always verify current prescribing information from official sources before initiating or modifying therapy.*
