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Mefenamic Acid (ISTAN) is not recommended for use in pregnant women, and those with renal or hepatic impairment particularly in the elderly. It should not be administered with coumarin anticoagulants.
It should be given with care to the elderly, to patients with asthma or bronchospasm, bleeding disorders, cardiovascular disease, a history of peptic ulceration, and in liver or renal failure. Patients with congestive heart failure, cirrhosis, diuretic-induced volume depletion or renal insufficiency require local synthesis of vasodilating prostaglandins to maintain renal perfusion and therefore these patients are at greater risk of developing renal dysfunction due to NSAID induced inhibition of renal prostaglandin synthesis.
