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# Meftal (Mefenamic Acid)
## Overview
NSAID (fenamate class) with analgesic, anti-inflammatory, antipyretic properties. Inhibits COX-1/2, also antagonizes prostaglandin at receptor level.
## Primary Indications
- Primary dysmenorrhea
- Mild-to-moderate pain (dental, muscular, headache)
- Febrile states
## Adult Dosing
- **Usual**: 500mg three times daily with food
- **Maximum**: 1.5g daily, duration ≤7 days
- Dysmenorrhea: 500mg initially, then 250mg q6h PRN
## Pediatric Dosing
**Established only for ages ≥14 years**
- 25mg/kg/day in 3-4 divided doses, not exceeding adult doses
- <14 years: Not FDA-approved; local protocols vary widely—seek specialist guidance
## Dose Adjustments
- **Renal impairment**: Avoid if CrCl <30 mL/min. Use caution if CrCl 30–60 mL/min
- **Hepatic impairment**: Contraindicated in active liver disease
- **Elderly**: Start at lowest effective dose; avoid prolonged use
## Contraindications
- Active peptic ulcer or GI bleeding
- Severe renal/hepatic impairment
- Concomitant aspirin/other NSAIDs
- Known hypersensitivity (may cross-react with aspirin)
- Third trimester of pregnancy
## Adverse Effects
- **Common**: GI upset, diarrhea, nausea, headache, dizziness
- **Serious**: GI bleeding/ulceration, renal impairment, hypertension, hypersensitivity (Stevens-Johnson syndrome rare)
## Key Drug Interactions
- **Anticoagulants** (warfarin, DOACs): Increased bleeding risk
- **Lithium, methotrexate, digoxin**: Mefenamic acid reduces clearance
- **Antihypertensives**: Reduced effect
- **Corticosteroids**: Linked to higher GI bleed risk
## Monitoring
- Renal function (baseline, then if prolonged use)
- GI symptoms (especially occult bleeding)
- Blood pressure in hypertensive patients
## Clinical Pearls
- Take with food/milk to reduce GI effects
- Better suited for dysmenorrhea than other NSAIDs due to uterine smooth muscle modulation
- Avoid in patients with inflammatory bowel disease
- Do not exceed 7-day continuous use unless directed
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*Educational disclaimer: This information is for healthcare professional reference. Always verify current dosing and safety data via official prescribing information (e.g., manufacturer labeling, national formulary) before making clinical decisions.*
