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# Mefenamic Acid (Meftal Spas)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the fenamate class. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Short-term management of mild to moderate pain, including dysmenorrhea.
* Treatment of fever.
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, typically started at the onset of pain or bleeding.
* **Maximum Dose:** Not to exceed 1250 mg in a 24-hour period. Treatment duration should generally not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is not generally recommended for use in children under 14 years of age due to safety concerns and limited data. Specific pediatric dosing is not well-established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Data is limited, but dose reduction may be considered in severe impairment.
* **Hepatic Impairment:** Use with caution. Data is limited, but dose reduction may be considered in severe impairment.
* **Elderly:** Use with caution; increased risk of adverse effects.
## Contraindications
* 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 history of recurrent gastrointestinal bleeding.
* Severe renal, hepatic, or cardiac impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis); hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions; hematologic abnormalities; bronchospasm.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of gastrointestinal bleeding.
* **Diuretics & Antihypertensives:** May reduce the efficacy of antihypertensives and increase the risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **Renal function:** Particularly in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Baseline and periodic monitoring may be considered.
* **Gastrointestinal symptoms:** Monitor for signs and symptoms of bleeding or ulceration.
* **Blood pressure:** NSAIDs can cause or worsen hypertension.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* Due to potential for dizziness and drowsiness, caution patients about operating machinery or driving.
* Limit use to the shortest duration necessary to control symptoms.
* Discontinue if new or worsening gastrointestinal symptoms, signs of hepatic dysfunction, or cardiovascular events occur.
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**Disclaimer:** This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and local guidelines before initiating or modifying therapy.
