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## Mefenamic Acid
### Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term relief of mild to moderate pain. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
### Primary Indications
* Pain, including menstrual pain (dysmenorrhea)
* Mild to moderate pain of other origins
### Adult Dosing
* **Initial dose:** 500 mg orally every 4 to 6 hours as needed.
* **Maximum daily dose:** 1500 mg orally per day.
* **Duration:** Not recommended for use beyond 7 days.
### Pediatric Dosing
Mefenamic acid is **not recommended** for use in children under 14 years of age due to lack of established safety and efficacy.
### Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution and close monitoring are advised due to potential for NSAID-related toxicity.
### Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, allergic rhinitis, or urticaria following NSAID or aspirin use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or ulceration; history of recurrent GI ulceration or bleeding.
* Severe renal, hepatic, or cardiac impairment.
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, constipation.
* **Serious:** GI bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis); hepatic toxicity; cardiovascular thrombotic events; hypersensitivity reactions; exacerbation of asthma.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Other NSAIDs and Aspirin:** Increased risk of GI toxicity, renal toxicity, and potential for additive pharmacodynamic effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
### Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Particularly with long-term use or in patients with liver disease.
* **Signs and symptoms of GI bleeding:** Hematemesis, melena, abdominal pain.
* **Blood pressure:** NSAIDs can cause or worsen hypertension.
### Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize GI upset.
* Limit use to the shortest duration necessary to control symptoms.
* Due to its potential for significant GI adverse effects, it should be used cautiously in elderly patients and those with a history of GI problems.
* Diarrhea can be a dose-limiting side effect.
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***Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the current prescribing information or a qualified healthcare professional for the most up-to-date and comprehensive drug details before making any treatment decisions.*
