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# Meftal (Mefenamic Acid)
## Overview
Mefenamic acid is an anthranilic acid derivative non-steroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties by non-selectively inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Treatment of mild to moderate pain.
* Primary dysmenorrhea.
## Adult Dosing
* **Standard Dose:** 500 mg initially, followed by 250 mg every 6 hours as needed.
* **Maximum Duration:** Should not exceed 7 days of continuous therapy.
## Pediatric Dosing
* **Children >14 years:** Generally follow adult dosing.
* **Children <14 years:** Safety and efficacy have not been established; use is generally not recommended unless under specialized pediatric rheumatology guidance.
## Dose Adjustments
* **Renal Impairment:** Avoid in severe renal impairment. Use with extreme caution in mild-to-moderate impairment; monitor for fluid retention and renal function decline.
* **Hepatic Impairment:** Use with caution; monitor for hepatotoxicity.
* **Geriatrics:** Start at the lowest effective dose; increased risk of serious gastrointestinal (GI) and cardiovascular (CV) adverse events.
## Contraindications
* Known hypersensitivity to mefenamic acid or other NSAIDs (including aspirin-sensitive asthma).
* History of GI bleeding or active ulceration.
* Pre-operative pain associated with coronary artery bypass graft (CABG) surgery.
* Severe renal or hepatic failure.
* Third trimester of pregnancy (risk of premature closure of the ductus arteriosus).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia.
* **Serious:** GI ulceration or hemorrhage, hypertension, fluid retention/edema, increased risk of CV thrombotic events (myocardial infarction, stroke), renal impairment, and blood dyscrasias.
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding.
* **Antihypertensives (ACE inhibitors, ARBs, Beta-blockers, Diuretics):** Reduced efficacy of antihypertensive therapy and increased risk of acute renal failure.
* **Corticosteroids/SSRIs:** Increased risk of GI ulceration.
* **Lithium/Methotrexate:** May increase plasma concentrations and toxicity risk.
## Monitoring
* **GI:** Monitor for signs of occult blood loss or epigastric discomfort.
* **Renal:** Periodic monitoring of serum creatinine, BUN, and electrolytes, especially in high-risk patients.
* **CV/BP:** Monitor blood pressure during therapy.
* **Clinical:** Observe for signs of edema or worsening asthma.
## Clinical Pearls
* **Administration:** Take with food or milk to minimize gastrointestinal irritation.
* **CV Warning:** Like all NSAIDs, mefenamic acid carries a Black Box Warning for increased risk of serious cardiovascular thrombotic events and serious gastrointestinal adverse events.
* **Acute Use:** Mefenamic acid is intended for short-term use only (maximum 7 days). Its role in chronic pain management is limited due to the GI safety profile compared to other NSAIDs.
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*Disclaimer: This information is for educational purposes only. Dosing protocols may vary by clinical setting or local guidelines. Always verify current prescribing information, contraindications, and drug interactions via official drug databases or institutional formularies before prescribing or administering medication.*
