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# Meftal (mefenamic acid)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the fenamate class. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain.
* Menstrual pain (dysmenorrhea).
## Adult Dosing
* **Pain:** 500 mg every 6 hours as needed. Do not exceed 3 days of treatment.
* **Dysmenorrhea:** 500 mg every 6 hours as needed, starting at the onset of pain or bleeding, whichever comes first. Do not exceed 3 days of treatment.
## Pediatric Dosing
Mefenamic acid is **not recommended** for use in children under 14 years of age due to lack of established safety and efficacy data.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, however, caution is advised and lowest effective dose should be used.
## Contraindications
* Hypersensitivity to mefenamic acid or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or history of recurrent GI ulceration or bleeding.
* Severe renal impairment.
* Severe hepatic impairment.
* Severe heart failure.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, constipation, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; 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 GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI bleeding.
* **Lithium:** Increased serum lithium levels; toxic effects.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Diuretics and antihypertensives:** NSAIDs may reduce their efficacy and increase risk of renal impairment.
## Monitoring
* Signs and symptoms of GI bleeding.
* Renal function (especially in patients with pre-existing renal disease or at risk).
* Hepatic function.
* Blood pressure.
## Clinical Pearls
* Mefenamic acid is generally intended for short-term use (maximum 3 days).
* Should be taken with food or milk to minimize GI upset.
* Due to risk of serious GI events, consider lowest effective dose for shortest duration.
* Diarrhea is a prominent adverse effect and may necessitate discontinuation.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. This summary does not replace comprehensive drug information resources.*
