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# Meftal spas
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) from the anthranilic acid derivatives class. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Mild to moderate pain, including dysmenorrhea.
* Inflammatory conditions.
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg every 6 to 8 hours as needed.
* **Maximum:** 1500 mg per day.
## Pediatric Dosing
* **Ages 6 months to 12 years:** 5 to 7 mg/kg/dose orally every 6 to 8 hours as needed.
* **Maximum pediatric dose:** Not to exceed adult maximum.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Data is limited, but reduced doses may be considered. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Data is limited, but reduced doses may be considered. Avoid in severe hepatic impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or history of recurrent GI ulceration/bleeding.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation.
* **Serious:**
* GI: Ulceration, bleeding, perforation.
* Cardiovascular: Increased risk of myocardial infarction and stroke (especially with chronic use).
* Renal: Renal papillary necrosis, interstitial nephritis, nephrotic syndrome, renal failure.
* Hepatic: Elevated liver enzymes, hepatitis.
* Hematologic: Anemia, leukopenia, thrombocytopenia.
* Hypersensitivity: Rash, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis.
* Other: Bronchospasm (especially in aspirin-sensitive asthma), headache, dizziness.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Lithium:** Increased lithium levels. Monitor lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **Baseline:** Renal function (creatinine), liver function tests (ALT, AST), complete blood count (CBC).
* **Periodic:** Continue monitoring renal function, liver function tests, CBC, and for signs/symptoms of GI bleeding, cardiovascular events, and hypersensitivity reactions.
## Clinical Pearls
* Mefenamic acid is generally recommended for short-term use due to the risk of GI and cardiovascular adverse effects.
* Administer with food or milk to minimize GI upset.
* Ensure adequate hydration.
* Avoid use in patients with known aspirin sensitivity.
* Effectiveness for dysmenorrhea is thought to be related to inhibition of prostaglandin synthesis in the uterus.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines before making any treatment decisions. Local protocols may vary.
