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# Mefenamic Acid (Meftal-P)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the fenamate class. It exerts its analgesic and anti-inflammatory effects through the inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Short-term management of mild to moderate pain, including menstrual pain (dysmenorrhea).
* Pain associated with inflammatory conditions.
## Adult Dosing
* **Pain:** 500 mg orally every 6 hours as needed.
* **Maximum Daily Dose:** 1500 mg. Treatment duration should not exceed 7 days.
## Pediatric Dosing
* **Pain:** 6.5 mg/kg orally every 6 hours as needed.
* **Maximum Daily Dose:** Not to exceed 500 mg per day.
* **Note:** Mefenamic acid is generally not recommended for children under 14 years of age due to potential safety concerns and limited data. Specific pediatric dosing may depend on local protocols and physician judgment.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose adjustment may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Dose adjustment may be necessary in severe hepatic impairment.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* History of NSAID-induced bronchospasm, urticaria, or allergic-type reactions.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or a history of recurrent gastrointestinal bleeding.
* Severe heart failure, renal failure, or hepatic failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, headache, dizziness, rash.
* **Serious:**
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and hypertension.
* **Gastrointestinal:** Ulceration, bleeding, perforation of the stomach or intestines.
* **Renal:** Acute kidney injury, interstitial nephritis, papillary necrosis.
* **Hepatic:** Hepatotoxicity, elevated liver enzymes.
* **Hematologic:** Anemia, leukopenia, thrombocytopenia.
* **Dermatologic:** Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Hypersensitivity:** Anaphylaxis, angioedema.
## 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.
* **Lithium:** Increased serum lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Diuretics, ACE inhibitors, Angiotensin II Receptor Blockers (ARBs):** May reduce antihypertensive effects and increase risk of renal impairment.
## Monitoring
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Monitor liver enzymes (ALT, AST), especially in patients with pre-existing liver disease or those on long-term therapy.
* **Gastrointestinal symptoms:** Educate patients to report any signs of bleeding (e.g., black, tarry stools, hematemesis).
* **Blood pressure:** Monitor for potential increases in blood pressure.
## Clinical Pearls
* Mefenamic acid is typically used for short-term pain relief.
* Administer with food or milk to minimize gastrointestinal upset.
* Avoid concurrent use with other NSAIDs.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Be aware of the increased risk of serious cardiovascular and gastrointestinal events associated with NSAID use.
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*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to ensure the appropriateness of any medication for your specific condition and to review the most current prescribing information.*
