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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the relief of mild to moderate pain.
## Primary Indications
* Pain (e.g., dysmenorrhea, dental pain, headache)
## Adult Dosing
* **Initial dose:** 500 mg orally every 6 to 8 hours as needed.
* **Maximum dose:** 1500 mg orally per day.
* Treatment should not exceed 7 days.
## Pediatric Dosing
* **Children 12 years and older:** Same as adult dosing.
* **Children younger than 12 years:** Safety and efficacy have not been established. Use is generally not recommended.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Not recommended in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Not recommended in severe hepatic impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid, aspirin, other NSAIDs, or any component of the formulation.
* History of NSAID-induced bronchospasm, urticaria, or allergic rhinitis.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or ulceration.
* Inflammatory bowel disease (active).
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, headache, rash, dizziness.
* **Serious:**
* Cardiovascular thrombotic events (MI, stroke)
* GI ulceration, bleeding, perforation
* Hepatotoxicity
* Nephrotoxicity
* Hypersensitivity reactions (including anaphylaxis)
* Severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis)
* Fluid retention and edema
* Exacerbation of asthma
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI bleeding.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (creatinine, BUN).
* Liver function tests (LFTs).
* Blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Short-term use only; generally not recommended for more than 7 days.
* Avoid in patients with a history of NSAID-related GI events.
* Consider alternative analgesics if there are contraindications or concerns regarding NSAID use.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.
