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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 indicated for the treatment 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 every 6 hours as needed. Do not exceed 1500 mg in a 24-hour period for the first 7 days of treatment; subsequent treatment should not exceed 1000 mg per day.
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain and bleeding, and continuing for the duration of the symptoms (typically 2-3 days).
## Pediatric Dosing
Mefenamic acid is generally not recommended for children under 14 years of age for pain management due to lack of established dosing and potential safety concerns. Specific indications and dosing for younger populations may exist in certain regions but require strict adherence to local guidelines and expert consultation.
## Dose Adjustments
No specific dose adjustments are routinely recommended for renal or hepatic impairment. However, caution is advised, and lowest effective doses should be used. Mefenamic acid is generally contraindicated in severe renal or hepatic impairment.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe heart failure, renal impairment, or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, flatulence.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis); hepatotoxicity; cardiovascular thrombotic events (myocardial infarction, stroke); hypersensitivity reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis); exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs or salicylates:** Increased risk of adverse effects.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* Monitor liver function tests.
* Assess for cardiovascular risk factors and monitor for signs of cardiovascular events.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only.
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Patients with asthma should use with caution due to the risk of bronchospasm.
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*Disclaimer: This information is intended for healthcare professionals and does not replace professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions.*
