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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. ## Primary Indications * Pain associated with osteoarthritis and rheumatoid arthritis. * Menstrual pain (dysmenorrhea). * Mild to moderate pain from other causes. ## Adult Dosing * **Pain:** 500 mg every 6 hours as needed. * **Dysmenorrhea:** 500 mg initially, followed by 250 mg every 6 hours as needed. * **Maximum:** Do not exceed 1250 mg in the first 24 hours of use, and do not exceed 1000 mg in any 24-hour period thereafter. Do not use for longer than 7 days. ## Pediatric Dosing * Mefenamic acid is generally not recommended for children under 14 years of age for pain management due to safety concerns and lack of established dosing. Specific indications and dosing may exist for certain conditions, requiring careful evaluation and adherence to specific guidelines. ## Dose Adjustments * **Renal Impairment:** Use with caution. No specific dose adjustments are established, but dose reduction may be considered in severe impairment. * **Hepatic Impairment:** Use with caution. No specific dose adjustments are established, but dose reduction may be considered in severe impairment. ## Contraindications * Hypersensitivity to mefenamic acid or other NSAIDs. * History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. * Inflammatory bowel disease. * Severe heart failure. * Third trimester of pregnancy. ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, headache, dizziness. * **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events; renal failure; hepatic failure; hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis. ## 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. * **Diuretics, ACE inhibitors, ARBs:** Reduced antihypertensive effect and increased risk of renal impairment. * **Lithium:** Increased lithium levels and potential toxicity. * **Methotrexate:** Increased methotrexate levels and potential toxicity. ## Monitoring * Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis). * Monitor renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy. * Monitor for signs of cardiovascular events. ## Clinical Pearls * Mefenamic acid is intended for short-term use only. * Administer with food or milk to minimize GI upset. * Avoid concurrent use with other NSAIDs or aspirin. * Consideration should be given to the lowest effective dose for the shortest duration necessary to reduce the risk of adverse events. *** *Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*