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# Mefenamic acid
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic and anti-inflammatory properties. It is primarily used for short-term relief of mild to moderate pain.
## Primary Indications
* Pain associated with menstruation (dysmenorrhea)
* Mild to moderate pain
## Adult Dosing
* **Dysmenorrhea:** 500 mg every 4 to 6 hours as needed. Maximum daily dose is 1250 mg. Treatment should not exceed 5 days per month.
* **Other pain:** 500 mg every 4 to 6 hours as needed. Maximum daily dose is 1250 mg. Treatment should not exceed 7 days.
## Pediatric Dosing
Mefenamic acid is generally not recommended for use in pediatric patients less than 14 years of age due to limited efficacy and safety data.
## Dose Adjustments
No specific dose adjustments are recommended for renal or hepatic impairment. However, caution is advised, and lower doses may be considered in patients with significant impairment.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs
* History of aspirin-induced asthma, urticaria, or allergic rhinitis
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery
* Active gastrointestinal bleeding or history of recurrent gastrointestinal ulcers or bleeding
* Severe renal or hepatic impairment
* Severe heart failure
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; anaphylaxis; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal adverse effects.
* **Diuretics and antihypertensives:** May decrease efficacy and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate levels and risk of toxicity.
## Monitoring
* **Gastrointestinal symptoms:** Monitor for signs and symptoms of bleeding and ulceration.
* **Renal function:** Particularly in patients with pre-existing renal disease or those taking diuretics.
* **Hepatic function:** Monitor liver function tests.
* **Blood pressure:** NSAIDs can increase blood pressure.
## Clinical Pearls
* Mefenamic acid should be taken with food or milk to minimize gastrointestinal upset.
* It is intended for short-term use only.
* Due to potential side effects, it is important to use the lowest effective dose for the shortest duration necessary.
* Prescribing decisions should consider the individual patient's risk factors for gastrointestinal bleeding, cardiovascular events, and renal dysfunction.
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*This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information and current clinical guidelines.*
