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# Mefenamic Acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of mild to moderate pain, including menstrual pain.
## Primary Indications
* Pain, mild to moderate
* Primary dysmenorrhea
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed.
* **Primary Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain.
* **Maximum Duration:** Typically not recommended for use longer than 7 days.
## Pediatric Dosing
Mefenamic acid is not generally recommended for use in children under 14 years of age due to potential safety concerns and lack of established dosing guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary. Mefenamic acid is primarily eliminated by the kidneys.
* **Hepatic Impairment:** Use with caution. Monitor liver function closely.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, allergic rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
* Pregnancy (third trimester).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, constipation, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic dysfunction; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **Renal function:** Baseline and periodically, especially in patients with pre-existing renal disease or those at risk for renal events.
* **Hepatic function:** Baseline and periodically, especially in patients with pre-existing liver disease or those receiving long-term therapy.
* **Gastrointestinal symptoms:** Advise patients to report any signs of bleeding or ulceration.
* **Blood pressure:** Monitor in patients with hypertension.
## Clinical Pearls
* Mefenamic acid is intended for short-term use only.
* Administer with food or milk to minimize gastrointestinal upset.
* Be aware of the potential for bronchospasm in aspirin-sensitive individuals.
* NSAIDs carry a boxed warning for cardiovascular and gastrointestinal risks.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before making clinical decisions.*
