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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) that acts primarily by inhibiting the cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Primary dysmenorrhea.
* Mild to moderate pain (short-term use, generally ≤7 days).
* *Note: "Meftal-P" specifically is often marketed as a pediatric suspension containing mefenamic acid and paracetamol; ensure formulation verification prior to administration.*
## Adult Dosing
* **Pain/Dysmenorrhea:** 500 mg orally initially, followed by 250 mg every 6 hours as needed.
* **Maximum Dose:** 1,500 mg per day. Treatment duration should not exceed 7 days.
## Pediatric Dosing
* **Children >6 months:** Dosing varies significantly by local protocol and specific brand concentration.
* **Common range:** 15–25 mg/kg/day in divided doses.
* **Warning:** Meftal-P (as a combination product) includes paracetamol; do not exceed the maximum daily limit for paracetamol (typically 60-90 mg/kg/day in divided doses). Always verify the specific suspension concentration regarding mg/mL.
## Dose Adjustments
* **Renal Impairment:** Use with caution; generally contraindicated in severe renal failure. Monitor creatinine clearance.
* **Hepatic Impairment:** Use with caution; monitor for hepatotoxicity.
* **Elderly:** Use the lowest effective dose for the shortest duration due to increased risk of gastrointestinal (GI) and cardiovascular (CV) adverse events.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active peptic ulceration or inflammatory bowel disease.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Severe renal or hepatic impairment.
## Adverse Effects
* **Gastrointestinal:** Nausea, abdominal pain, diarrhea (common), peptic ulceration, GI bleeding.
* **Renal:** Fluid retention, edema, acute renal failure.
* **Cardiovascular:** Increased risk of hypertension, myocardial infarction, and stroke (class effect of NSAIDs).
* **Hematologic:** Anemia, thrombocytopenia (rare but serious).
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Antiplatelet Agents/SSRIs:** Increased gastrointestinal ulceration/bleeding risk.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of nephrotoxicity.
* **Lithium/Methotrexate:** NSAIDs may decrease the renal clearance of these drugs, increasing toxicity.
## Monitoring
* Baseline and periodic monitoring of renal function (BUN/SCr) and liver enzymes.
* Monitor hemoglobin/hematocrit if long-term therapy is anticipated (due to occult GI blood loss).
* Assess for signs of GI bleeding or cardiovascular symptoms.
## Clinical Pearls
* **Take with food:** Administering with food or milk may help reduce gastric irritation.
* **Duration:** Limit use due to the risk of dose-related toxicity.
* **Combination Risks:** If using "Meftal-P" (combination with paracetamol), ensure the patient is not taking other paracetamol-containing products to avoid hepatotoxicity from overdose.
* **Pregnancy:** Strictly avoid, particularly in the third trimester (premature closure of ductus arteriosus).
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**Disclaimer:** This information is for educational purposes only. Drug dosing, indications, and safety profiles can change. Always verify the specific product concentration and prescribing information with local clinical guidelines and current manufacturer labeling before administration.
