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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is an anthranilic acid derivative categorized as a nonsteroidal anti-inflammatory drug (NSAID). It possesses analgesic, anti-inflammatory, and antipyretic properties by inhibiting the cyclooxygenase (COX) enzyme, thereby reducing prostaglandin synthesis.
## Primary Indications
* Primary dysmenorrhea.
* Mild to moderate pain.
* *Note: "Meftal-P" is often a brand-specific pediatric formulation (suspension) used as an antipyretic and analgesic.*
## Adult Dosing
* **Standard Dose:** 500 mg orally initially, followed by 250 mg every 6 hours as needed.
* **Maximum Duration:** Should not exceed 7 days of continuous therapy.
## Pediatric Dosing
* **Standard Dose:** 6.5 mg/kg orally every 6 to 8 hours as needed.
* **Maximum Dose:** Do not exceed 500 mg per dose or 1500 mg per day.
* **Age Restriction:** Generally not recommended for children under 6 months of age without specialized clinical oversight.
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Avoid in cases of severe renal impairment (CrCl < 30 mL/min).
* **Hepatic Impairment:** Use with caution; monitor liver function tests. Dose reduction may be required.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs (including aspirin triad).
* History of gastrointestinal (GI) bleeding or active peptic ulcer disease.
* Perioperative setting of coronary artery bypass graft (CABG) surgery.
* Severe heart failure or severe renal/hepatic impairment.
* History of asthma induced by NSAIDs.
## Adverse Effects
* **GI:** Diarrhea (frequent), nausea, dyspepsia, gastrointestinal ulceration/bleeding.
* **CNS:** Dizziness, headache, drowsiness.
* **Hematologic:** Anemia, thrombocytopenia (rare but serious).
* **Renal:** Fluid retention, edema, risk of acute kidney injury.
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** Increases risk of bleeding.
* **Antiplatelet agents:** Increased GI toxicity risk.
* **Lithium/Methotrexate:** NSAIDs may decrease renal clearance, increasing toxicity.
* **ACE Inhibitors/Diuretics:** Reduced antihypertensive effect and increased risk of acute renal failure.
## Monitoring
* Monitor for signs of GI bleeding (black/tarry stools, hematemesis).
* Monitor renal function (BUN/SCr) and blood pressure in patients with underlying heart or kidney disease.
* Monitor complete blood count (CBC) if used for long durations.
## Clinical Pearls
* **Duration:** Mefenamic acid is intended for short-term use only. Long-term use significantly increases the risk of serious CV and GI adverse events.
* **Administration:** Take with food or milk to minimize gastrointestinal upset.
* **Diarrhea:** Diarrhea is a dose-related side effect; if it occurs, the dosage should be reduced or the drug discontinued.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult current, local institutional guidelines and the manufacturer’s package insert before prescribing or administering medication. Clinical practice varies by region and specific patient comorbidities.
