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# Mefenamic Acid ## Overview Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for short-term symptomatic relief of mild to moderate pain and for primary dysmenorrhea. ## Primary Indications * Pain: Short-term management of mild to moderate pain. * Primary Dysmenorrhea: Symptomatic relief of menstrual pain. ## Adult Dosing * **Pain:** 500 mg every 8 hours as needed. Maximum dose: 1500 mg/day. * **Primary Dysmenorrhea:** 500 mg every 8 hours as needed, starting with the onset of pain or bleeding. Maximum dose: 1500 mg/day. Treatment duration is typically short, usually not exceeding 7 days. ## Pediatric Dosing Mefenamic acid is generally not recommended for children under 12 years of age due to lack of established safety and efficacy data. ## Dose Adjustments No specific dose adjustment is required for renal or hepatic impairment. However, caution is advised, and the lowest effective dose should be used. ## Contraindications * Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs. * History of NSAID-induced bronchospasm, asthma, urticaria, or allergic-type reactions. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. * Active gastrointestinal (GI) bleeding or history of recurrent GI ulceration or hemorrhage. * Severe renal, hepatic, or cardiac impairment. ## Adverse Effects Common: Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, headache, dizziness. Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity (including interstitial nephritis, papillary necrosis); hepatic toxicity; hypersensitivity reactions; bronchospasm; exacerbation of asthma. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **SSRIs and SNRIs:** Increased risk of GI bleeding. * **Other NSAIDs, Aspirin:** Increased risk of GI toxicity and reduced cardioprotective effects of low-dose aspirin. Avoid concomitant use if possible. * **ACE inhibitors, ARBs, Diuretics:** May reduce antihypertensive effect and increase risk of renal impairment. * **Lithium, Methotrexate:** Increased serum levels and risk of toxicity. * **Cyclosporine, Tacrolimus:** Increased risk of nephrotoxicity. ## Monitoring * **GI Bleeding:** Monitor for signs and symptoms (e.g., melena, hematemesis, abdominal pain). * **Renal Function:** Monitor BUN, creatinine, especially in patients with pre-existing renal disease or risk factors. * **Hepatic Function:** Monitor LFTs if treatment is prolonged or symptoms of hepatic dysfunction arise. * **Blood Pressure:** Monitor BP, especially in patients with hypertension. ## Clinical Pearls * Use for the shortest duration necessary. * Administer with food or milk to minimize GI upset. * Avoid use in patients with established cardiovascular disease or risk factors for it. * Consider prophylactic GI protection (e.g., PPI) in patients at high risk for GI events. * Mefenamic acid is typically used for short-term pain management and dysmenorrhea; other NSAIDs or analgesics may be preferred for chronic pain. --- **Disclaimer:** This information is intended for educational purposes only and does not constitute medical advice. Always consult with a healthcare professional and refer to current prescribing information for the most up-to-date and complete drug details.