Reevaluating Mefenamic Acid: Central Nervous System Effects and Risk of Acute Kidney Injury

Mefenamic Acid Overdose: New Concerns emerge Over Neurological and Kidney Impacts

October 31, 2025 – A renewed examination of mefenamic acid poisoning cases is revealing a concerning link between overdose and severe central nervous system toxicity, and also acute kidney injury.New data urges medical professionals and the public to understand the potential risks associated with this widely used nonsteroidal anti-inflammatory drug (NSAID).

Previously considered relatively safe in overdose situations compared to other NSAIDs, mefenamic acid is now recognized as a potential cause of significant health problems, even without coinciding medical conditions. The increased attention is stemming from a growing number of reported cases showing adverse effects.

Neurological Complications: A Rising Concern

Reports indicate that mefenamic acid poisoning can trigger a range of neurological symptoms. These can include seizures, altered mental status, and in severe instances, coma. The mechanism behind this neurotoxicity isn’t fully understood, but research suggests it may involve interference with neurotransmitter systems or direct damage to brain cells.

According to the CDC, adverse drug events contribute to approximately 1.3 million emergency department visits each year. While mefenamic acid isn’t typically a leading cause, the emerging data suggests it should be considered in cases of unexplained neurological distress, notably in patients with a history of NSAID use.

Acute Kidney Injury: A Significant Risk

Alongside neurological effects, acute kidney injury is also being increasingly identified as a consequence of mefenamic acid overdose. The drug can reduce blood flow to the kidneys, leading to damage and impaired function. This risk is heightened in individuals with pre-existing kidney problems, dehydration, or other medical conditions.

Pro Tip: maintaining adequate hydration is crucial when taking any NSAID, including mefenamic acid. This helps support kidney function and reduces the risk of complications.

Understanding the Risks: A Comparative Look

Symptom	Mild Overdose	Severe Overdose
Neurological effects	Dizziness, Headache	Seizures, Coma
Kidney Function	Slightly reduced Urine Output	Acute Kidney Injury, Kidney Failure
Gastrointestinal	Nausea, Vomiting	Severe Abdominal Pain, Gastrointestinal bleeding

It’s essential to remember that the severity of symptoms can vary depending on the amount of mefenamic acid ingested, the individual’s overall health, and other factors.

What To Do In Case of Suspected Overdose

Immediate medical attention is critical if mefenamic acid poisoning is suspected. Symptoms can be delayed, and prompt intervention is crucial to minimize potential damage. Contact emergency services or a poison control center immediately. Do not attempt to induce vomiting unless directed by a medical professional.

Did You Know? The American Association of Poison Control Centers (AAPCC) maintains a 24/7 hotline that can provide immediate guidance in cases of suspected poisoning: 1-800-222-1222.

This case emphasizes the importance of careful medication management, clear labeling, and patient education.

What steps do you think healthcare providers should take to better educate patients about the risks of mefenamic acid? How can individuals minimize their risk when taking this medication?

Mefenamic Acid: A Deeper Dive

Mefenamic acid is a member of the fenamate class of NSAIDs, primarily used to relieve pain and reduce inflammation. It’s commonly prescribed for menstrual pain, but can also be used for other conditions like headaches and muscle aches. It effectively works by blocking the production of prostaglandins,chemicals that contribute to pain and inflammation.

However, like all medications, it carries potential side effects. Common side effects include gastrointestinal issues like nausea and stomach upset. Less common but more serious side effects, as highlighted by recent findings, involve the nervous system and kidneys.

Frequently Asked Questions about Mefenamic Acid Poisoning

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What are the key neurological side effects beyond headache and dizziness that healthcare professionals should be aware of when prescribing mefenamic acid?

Understanding Mefenamic Acid & its Uses

Mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID), remains a frequently prescribed medication for managing mild to moderate pain, including dysmenorrhea (menstrual pain), and inflammatory conditions. While effective, a growing body of evidence necessitates a reevaluation of its safety profile, especially concerning potential neurological side effects and the heightened risk of acute kidney injury (AKI). This article delves into these critical areas,providing healthcare professionals and patients with updated information for informed decision-making. Common brand names include Ponstan and Feldene.

Central Nervous System (CNS) Effects: Beyond Headache & Dizziness

Traditionally,mefenamic acid’s CNS side effects were considered relatively mild – headaches,dizziness,and somnolence. however, more recent reports and post-market surveillance data suggest a broader spectrum of neurological complications.

* Aseptic Meningitis: Though rare, aseptic meningitis – inflammation of the meninges without bacterial infection – has been linked to mefenamic acid use. Symptoms mimic bacterial meningitis, requiring prompt medical attention.

* Seizures: Patients with pre-existing seizure disorders are at increased risk. even in individuals without a history of epilepsy, mefenamic acid can lower the seizure threshold.

* Cognitive impairment: Reports indicate potential for cognitive dysfunction, including confusion, memory problems, and difficulty concentrating, particularly in elderly patients.

* Mood Alterations: Cases of depression, anxiety, and even psychosis have been associated with NSAID use, including mefenamic acid, though causality remains complex.

* Visual Disturbances: Blurred vision and other visual disturbances have been reported, warranting careful monitoring.

Risk Factors for CNS Complications:

* Pre-existing neurological conditions (epilepsy, migraine)

* Elderly patients

* High doses or prolonged use

* Concomitant use of other CNS-depressant medications (e.g., benzodiazepines, opioids)

* Dehydration

Acute Kidney Injury (AKI): A Significant Concern

The association between NSAIDs and AKI is well-established. Mefenamic acid, like other nsaids, inhibits prostaglandin synthesis. Prostaglandins play a crucial role in maintaining renal blood flow, especially in individuals with compromised kidney function.

Mechanisms of AKI with Mefenamic Acid:

1. decreased Renal Blood Flow: Prostaglandin inhibition leads to vasoconstriction of afferent arterioles,reducing blood flow to the kidneys.
2. Interstitial Nephritis: Mefenamic acid can induce acute interstitial nephritis, an inflammation of the kidney tubules and surrounding tissues.
3. Prerenal Azotemia: reduced renal blood flow can cause prerenal azotemia, a buildup of nitrogenous waste products in the blood.
4. Sodium and Water Retention: NSAIDs can promote sodium and water retention, exacerbating edema and possibly leading to heart failure in susceptible individuals.

Identifying Patients at High Risk for AKI:

* Pre-existing Kidney Disease: Chronic kidney disease (CKD) significantly increases vulnerability.

* Heart Failure: Reduced cardiac output compromises renal perfusion.

* Diabetes Mellitus: Diabetic nephropathy increases susceptibility to AKI.

* Hypertension: Uncontrolled hypertension damages renal blood vessels.

* Dehydration: Reduced fluid volume exacerbates the effects of prostaglandin inhibition.

* Elderly Patients: Age-related decline in renal function.

* Concomitant Medications: Use of ACE inhibitors, ARBs, diuretics, or other nephrotoxic drugs.

Monitoring & Management Strategies

Proactive monitoring and careful management are crucial to mitigate the risks associated with mefenamic acid.

* Baseline Renal Function Tests: Before initiating mefenamic acid, assess serum creatinine and estimated glomerular filtration rate (eGFR).

* Regular Monitoring: Repeat renal function tests periodically, especially in high-risk patients and during prolonged treatment.

* Hydration: Encourage adequate fluid intake to maintain renal perfusion.

* Dose Optimization: Use the lowest effective dose for the shortest duration possible.

* Avoidance in High-Risk Patients: Consider option analgesics in patients with significant risk factors for AKI or CNS complications.

* Drug Interactions: Carefully review the patient’s medication list for potential interactions.

* Patient Education: Inform patients about the potential side effects and the importance of reporting any concerning symptoms (e.g., changes in urine output, swelling, neurological symptoms).

Case Study: Atypical presentation of Mefenamic Acid-Induced AKI

In 2023, a 78-year-old female with a history of hypertension and mild CKD presented with acute onset lower extremity edema and fatigue three days after starting mefenamic acid for osteoarthritis pain. Initial assessment revealed normal urine output,but subsequent laboratory tests showed a significant