In this mefenamic acid review, we will discuss the following:
- what is mefenamic acid?
- mefenamic acid formulations
- registered uses
- dysmenorrhea (period pains)
- dosage of mefenamic acid
- precautions and disadvantages
WHAT IS MEFENAMIC ACID?
Mefenamic acid is a Non-Steroidal Anti-Inflammatory Drug (NSAID). It belongs to the same class of drugs as aspirin, ibuprofen, indomethacin, diclofenac, etc.
NSAIDs exhibit their analgesic and anti-inflammatory activity by inhibiting cyclo-oxygenase. This is an enzyme that leads to the production of mediators of pain and inflammation called prostaglandins.
The drug has been in use for more than half a century.
MEFENAMIC ACID FORMULATIONS
Mefenamic acid is taken by mouth, or used rectally as suppositories. There is no injectable formulation of mefenamic acid.
Among the oral formulations, there exist:
- mefenamic acid suspension
- mefenamic acid capsules
- mefenamic acid tablets
The strength of the different formulations is as follows:
- mefenamic acid suspension 50mg per 5ml
- mefenamic acid capsules 250mg
- mefenamic acid tablets 500mg
- mefenamic acid suppositories 125mg
REGISTERED USES OF MEFENAMIC ACID
- Treatment of mild to moderate pain
- Treatment of inflammation e.g. in rheumatoid arthritis, gout
- Treatment of period pains (expanded below), perimenstrual syndrome including menstrual migraine
- Management of fever (in children)
DYSMENORRHEA (PERIOD PAINS)
The specific use of mefenamic acid for dysmenorrhea or period pains, needs to be elaborated upon. This is because dysmenorrhea can be a very difficult condition to manage. It also causes a great deal of misery to millions of women.
Dysmenorrhea has two types:
- primary dysmenorrhea – onset right from the beginning of menses
- secondary dysmenorrhea – onset a while after the commencement of menstrual periods
Mefenamic acid tends to beat many other NSAIDs in controlling dysmenorrhea. It is highly effective. What needs to be emphasised, is that in the case of secondary dysmenorrhea, investigations have to be undertaken.
This is because secondary dysmenorrhea usually points to an underlying cause. Such pathology needs to be ruled out, before mefenamic acid can be prescribed. Pathology usually found at investigation includes infections (pelvic inflammatory disease), uterine fibroids, or even cancer.
DOSAGE OF MEFENAMIC ACID
For adults, the oral dosage is usually 500mg three times daily.
Adolescents can take 1 capsule (250mg) three times daily.
The dose of the suspension differs by age of the child. Please consult the package insert strictly.
The dose of the suppositories differs between children and adults. Please consult the package insert.
Mefenamic acid, like other NSAIDs, should be taken with, or immediately after meals. This is to minimise the risk of gastrointestinal side effects.
PRECAUTIONS AND DISADVANTAGES
Mefenamic acid has the disadvantage of being significantly more expensive than other NSAIDs. In some countries, its cost is exorbitant! However, for conditions like intractable dysmenorrhea, the cost may be worthwhile, given also the efficacy of mefenamic acid.
Like other non-steroidal anti-inflammatory agents that work by inhibiting cyclo-oxygenase, mefenamic acid can cause gastrointestinal tract ulceration, bleeding and perforation. The risk is highest in elderly people above the age of 70, and in people with a history of intolerance of NSAIDs.
Mefenamic acid can have side-effects on the heart and other parts of the body. It can, especially in combination analgesics and / or when taken for too long, damage the kidneys. These side-effects are not peculiar to mefenamic acid, but hold true for other NSAIDs, to differing extents.
In the management of COVID-19, paracetamol is preferred to NSAIDs.
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