Mefenamic Acid Pronunciation: (MEH-fen-AM-ik acid) Class: NSAID Trade Names Ponstel - Capsules 250 mg Apo-Mefenamic (Canada) Pharmacology

Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis. Pharmacokinetic Parameter Estimates for Mefenamic Acid Normal Healthy Adults PK Parameters (18-45 yr) Value Tmax(hr) 2 Oral clearance (L/hr) 21.23 Apparent volume of distribution; Vz/F 1.06 (L/kg) Half-life; t (hrs) 2 to 4 Peak plasma levels are attained in 2 to 4 hours and the elimination half-life approximates 2 hours. Greater than 90% bound to albumin. Indications and Usage Relief of moderate pain lasting less than 1 wk; treatment of primary dysmenorrhea. Unlabeled Uses Treatment of sunburn, migraine (acute attack), PMS. Contraindications Patients in whom aspirin, iodides, or any NSAID has caused allergic-type reactions; preexisting renal disease; active ulceration or chronic inflammation of GI tract. Dosage and Administration Acute Pain Adults and Children (14 yr or age and older) PO 500 mg, followed by 250 mg every 6 h as needed. Usually not used more than 1 wk. Primary Dysmenorrhea Adults and Children (14 yr of age and older) PO 500 mg, followed by 250 mg every 6 h starting with onset of bleeding and associated symptoms. Storage/Stability Store at room temperature (59 to 86F) in tightly closed, light-resistant container. Drug Interactions Anticoagulants Increased risk of gastric erosion and bleeding. Cyclosporine Nephrotoxicity of both agents may be increased. CYP-450 Exercise caution when coadministering mefenamic acid with drugs known to inhibit the isoenzyme 2C9. Lithium Serum lithium levels may be increased. Methotrexate

Increased methotrexate levels. Salicylates Additive GI toxicity. Laboratory Test Interactions May cause prolonged bleeding time or false-positive reaction for urinary bile using diazo tablet test. Adverse Reactions Cardiovascular Edema; weight gain; CHF; altered BP; palpitations; chest pain; bradycardia; tachycardia. CNS Headache; vertigo; drowsiness; dizziness; insomnia. Dermatologic Rash; urticaria; purpura. EENT Blurred vision; tinnitus; salivation; glossitis. GI Diarrhea; dry mouth; vomiting; abdominal pain; dyspepsia; GI bleeding; nausea; constipation; flatulence. Genitourinary Hematuria; proteinuria; dysuria; renal failure. Hematologic Decreased hematocrit; bleeding; neutropenia; leukopenia; pancytopenia; eosinophilia; thrombocytopenia. Hepatic Mild elevations in LFT results. Respiratory Bronchospasm; laryngeal edema; rhinitis; dyspnea; pharyngitis; hemoptysis; shortness of breath. Miscellaneous Autoimmune hemolytic anemia may occur if used long term. Precautions Warnings NSAIDs may cause an increased risk of serious CV thrombotic events, MI, and stroke, which can be fatal. This risk may increase with length of therapy. Patients with CV disease or risk factors for CV disease may be at greater risk. NSAIDs cause an increased risk of serious GI adverse reactions, including bleeding, inflammation, perforation of the stomach or intestines, and ulceration, which can be fatal. These events can occur any time during use and without warning symptoms. Elderly patients are at greater risk of serious GI events. Pregnancy Category C . Lactation Undetermined. Children Not recommended for children younger than 14 yr of age. Elderly Increased risk of adverse reactions. Hypersensitivity May occur; use with caution in aspirin-sensitive individuals because of possible cross sensitivity. Renal Function Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur. Lower doses may be necessary in patients with renal function impairment.

Diarrhea If diarrhea occurs, reduce dosage or temporarily discontinue. GI toxicity Bleeding, ulceration, or perforation can occur at any time, with or without warning symptoms. Rash Promptly discontinue if rash develops. Overdosage Symptoms Acute renal failure, coma, grand mal seizures, muscle twitching, status epilepticus. Patient Information Inform patient not to use drug for longer than 1 wk. If given for dysmenorrhea, instruct patient to begin taking drug with onset of bleeding and associated symptoms. Warn patient about potential for bleeding, and advise patient to notify other health care professionals that drug is being taken. Advise patient to discontinue medication if rash develops and to contact health care provider. Instruct patient to report the following symptoms to health care provider: rash, visual problems, dark stools, decreased urinary output, persistent headache or stomach pain and unusual bruising or bleeding. Advise patient to avoid intake of alcoholic beverages. Instruct patient that drug may cause drowsiness and to use caution while driving or performing other activities requiring mental alertness. Caution patient to avoid prolonged exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction. Instruct patient not to take OTC medications, including aspirin and ibuprofen or other prescription drugs, without consulting health care provider.