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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term management of mild to moderate pain. It also possesses anti-inflammatory and antipyretic properties.
## Primary Indications
* Mild to moderate pain, including menstrual pain (dysmenorrhea), dental pain, and headaches.
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed. Doses should not exceed 4000 mg per day.
* **Dysmenorrhea:** 500 mg orally every 6 hours starting at the onset of menstrual pain and associated symptoms.
## Pediatric Dosing
* **Pain and Dysmenorrhea:** Mefenamic acid is generally not recommended for children under 14 years of age. Safety and efficacy have not been established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment, but specific guidelines are not well-established.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment, but specific guidelines are not well-established.
* **Elderly:** No specific dose adjustment is usually required, but elderly patients are at higher risk for NSAID-related adverse effects.
## 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 bleeding or a history of recurrent gastrointestinal bleeding.
* Severe renal, hepatic, or cardiac impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal failure; hepatic failure; cardiovascular thrombotic events (e.g., myocardial infarction, stroke); hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs and SNRIs:** Increased risk of gastrointestinal bleeding.
* **Diuretics and Antihypertensives:** May decrease their efficacy and increase risk of renal toxicity.
* **Lithium and Methotrexate:** Increased serum concentrations and potential for toxicity.
## Monitoring
* **Baseline and periodic monitoring of renal function (creatinine, BUN) and hepatic function (transaminases).**
* **Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).**
* **Monitor for signs and symptoms of cardiovascular events.**
* **Monitor blood pressure, especially in patients with hypertension.**
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to potential for central nervous system effects, advise caution when driving or operating machinery.
* Duration of treatment should be as short as possible to minimize risks.
* Consider alternative analgesics if pain is severe or persistent.
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*Always verify current prescribing information and consult with a healthcare professional for personalized medical advice.*
