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# Meftal (mefenamic acid)
## Overview
Mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the fenamate class. It inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
## Primary Indications
* Short-term relief of mild to moderate pain, including menstrual pain (dysmenorrhea) and pain associated with conditions like headache and dental pain.
* Management of inflammatory conditions.
## Adult Dosing
* **Pain and Dysmenorrhea:** 500 mg initially, followed by 250 mg every 6 hours as needed.
* **Maximum Daily Dose:** 1500 mg. Dosing duration is typically limited to 7 days for self-medication.
## Pediatric Dosing
* **Age 12 years and older:** Dosing is the same as adults.
* **Children under 12 years:** Safety and efficacy have not been established. Use is not generally recommended.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be considered based on severity.
* **Hepatic Impairment:** Use with caution. Dose reduction may be considered based on severity.
## Contraindications
* Hypersensitivity to mefenamic acid, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, angioedema, or urticaria after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, diarrhea, abdominal pain, constipation, GI bleeding, ulceration, perforation.
* **Central Nervous System:** Dizziness, drowsiness, headache.
* **Dermatologic:** Rash, pruritus.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hematologic:** Anemia, leukopenia.
* **Cardiovascular:** Increased risk of cardiovascular thrombotic events, myocardial infarction, and stroke. Hypertension.
* **Other:** Bronchospasm, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Lithium:** Increased lithium levels and potential toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics and Antihypertensives:** Reduced efficacy; increased risk of nephrotoxicity.
## Monitoring
* **Renal function:** Periodically, especially in patients with pre-existing renal disease or those receiving long-term therapy.
* **Hepatic function:** Periodically, especially in patients with pre-existing hepatic disease.
* **Blood pressure:** Monitor for hypertension.
* **Signs of GI bleeding:** Stool guaiac, patient reported symptoms.
## Clinical Pearls
* Avoid concurrent use with other NSAIDs or aspirin to minimize adverse effects.
* Administer with food or milk to reduce gastrointestinal upset.
* Should not be used for prolonged periods due to risk of serious GI and cardiovascular events.
* Use the lowest effective dose for the shortest duration necessary.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before administering any medication. Drug information can change rapidly.
