Usage
This combination medication is primarily prescribed for managing and reducing excessive bleeding, particularly in conditions like heavy menstrual bleeding (menorrhagia) and bleeding after surgical procedures. It aids in normal blood clotting, thus supporting the natural healing process.
Pharmacological Classifications:
- Ethamsylate: Hemostatic agent
- Menadione (Vitamin K3): Vitamin, essential for blood clotting
- Citrus Bioflavonoids: Antioxidant, vascular protectant
- Tribasic Calcium Phosphate: Calcium and phosphate supplement, also contributes to clotting
Mechanism of Action: This combination works via multiple pathways: Ethamsylate enhances platelet adhesion and increases capillary resistance. Menadione is crucial for synthesizing clotting factors II, VII, IX, and X. Citrus Bioflavonoids improve vascular integrity and have antioxidant properties, while Tribasic Calcium Phosphate provides calcium necessary for the clotting cascade.
Alternate Names
- Hemsyl Cvp
- Pause-XT
- Tenxima XT Stop
How It Works
Pharmacodynamics: Ethamsylate promotes platelet adhesion and capillary resistance, reducing bleeding time. Menadione, a synthetic form of Vitamin K, is essential for hepatic synthesis of clotting factors II, VII, IX, and X. Citrus bioflavonoids act as antioxidants and may contribute to vascular wall stability. Calcium is vital for the clotting cascade.
Pharmacokinetics: The absorption, metabolism, and elimination of this specific combination have not been extensively studied. Ethamsylate is primarily excreted unchanged in the urine. Menadione is absorbed in the gastrointestinal tract and metabolized in the liver. Citrus bioflavonoids have variable absorption and metabolism. Calcium phosphate absorption occurs in the small intestine, facilitated by Vitamin D. It is primarily excreted through the kidneys.
Mode of Action: Ethamsylate acts by increasing platelet adhesiveness and improving capillary resistance, shortening bleeding time. Menadione is a cofactor in the post-translational carboxylation of glutamic acid residues in clotting factors, essential for their activity. Citrus bioflavonoids exhibit antioxidant effects, scavenging free radicals and potentially enhancing vascular integrity. Calcium ions are required for various steps in the coagulation cascade. Specific receptor binding, enzyme inhibition, or neurotransmitter modulation by this combination is not well-defined.
Elimination Pathways: Ethamsylate is primarily excreted unchanged in the urine. Menadione is metabolized in the liver and excreted in bile and urine. Citrus bioflavonoids undergo variable metabolism and excretion. Calcium phosphate is excreted mainly through the kidneys.
Dosage
Dosage information for this specific combination product is limited and often varies by brand name. It is essential to consult the specific product packaging or a healthcare professional for precise guidance. The following information is based on available data and should be verified for the particular brand prescribed.
Standard Dosage
Adults:
Dosage recommendations vary. Some sources suggest one tablet two to three times a day, while others recommend 500mg of ethamsylate up to four times a day during menstruation for menorrhagia, or 250-500mg every four to six hours post-surgery to manage hemorrhage. Always adhere to the prescribed dosage.
Children:
The safety and efficacy in children, particularly premenarcheal girls, have not been established. Use with extreme caution in adolescents under 18, under strict medical supervision.
Special Cases:
- Elderly Patients: Not recommended for postmenopausal women. Geriatric use should be carefully assessed, with dosage adjustments as needed.
- Patients with Renal Impairment: Use with caution. Dosage adjustments may be required due to the increased risk of hypercalcemia.
- Patients with Hepatic Dysfunction: Dosage adjustments may be necessary in severe liver disease due to menadione’s hepatic metabolism. Closely monitor liver function tests.
- Patients with Comorbid Conditions: Careful consideration is needed for patients with thromboembolic disorders, hypercalcemia, or nephrolithiasis.
Clinical Use Cases
Specific dosage recommendations for clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are not explicitly defined for this combination. Dosing is determined on a case-by-case basis, considering the specific clinical scenario and patient factors. Consult a specialist for individualized recommendations.
Dosage Adjustments
Dosage modifications are necessary based on patient-specific factors, including renal or hepatic dysfunction, age, and coexisting medical conditions. Close monitoring of calcium levels and coagulation parameters is advisable.
Side Effects
Common Side Effects:
- Headache
- Nausea
- Rash
- Tiredness
- Stomach pain
- Muscle or joint pain
- Diarrhea
- Nasal congestion
- Sinus pain
Rare but Serious Side Effects:
- Allergic reactions (e.g., skin rash, itching, swelling)
- Thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism)
- Hypercalcemia
Long-Term Effects:
Long-term effects of this combination are not well-established. However, chronic use might increase the risk of thromboembolic events and hypercalcemia, especially in susceptible individuals.
Adverse Drug Reactions (ADR):
Clinically significant ADRs include severe allergic reactions, thromboembolic complications, and marked hypercalcemia. These necessitate immediate medical intervention.
Contraindications
- Hypersensitivity to any of the components
- Active or history of thromboembolic disorders
- Hypercalcemia
- Renal calculi
- Hypophosphatemia
- Pre-existing color vision defects (for menadione assessment)
- Hemorrhage in the subdural or subarachnoid space
- Pregnancy (generally contraindicated)
Drug Interactions
- Anticoagulants (e.g., warfarin): Increased risk of bleeding or clotting.
- Hormonal contraceptives: Increased risk of thromboembolic events.
- Other calcium supplements: Risk of hypercalcemia.
- Medicines to manage leukemia (e.g., cyclophosphamide): Potential for calcium leakage from cells.
- Alcohol: May increase the risk of gastrointestinal side effects.
Pregnancy and Breastfeeding
This combination is generally contraindicated during pregnancy due to potential risks to the fetus. It should be used with caution during breastfeeding. Consult a doctor for alternative, safer options.
Drug Profile Summary
- Mechanism of Action: Multifaceted; ethamsylate enhances platelet function and capillary resistance, menadione supports clotting factor synthesis, citrus bioflavonoids act as antioxidants and may improve vascular integrity, and calcium is essential for coagulation.
- Side Effects: Headache, nausea, rash, tiredness, stomach pain, muscle or joint pain, diarrhea, nasal congestion, and sinus pain. Rarely, allergic reactions, thromboembolic events, and hypercalcemia.
- Contraindications: Hypersensitivity, thromboembolic disorders, hypercalcemia, pregnancy.
- Drug Interactions: Anticoagulants, hormonal contraceptives, calcium supplements, leukemia medications.
- Pregnancy & Breastfeeding: Contraindicated in pregnancy, use with caution during breastfeeding.
- Dosage: Varies; consult product packaging or a healthcare professional.
- Monitoring Parameters: Liver function tests, coagulation profile, calcium levels.
Popular Combinations
Specific popular combinations for this four-ingredient mix are not widely recognized in current clinical practice. However, the components may be present in various formulations with other drugs, each requiring individual evaluation.
Precautions
- General Precautions: Pre-screening for allergies, metabolic disorders, and organ dysfunction is recommended.
- Pregnant Women: Generally contraindicated.
- Breastfeeding Mothers: Use with caution; potential risk of neonatal exposure.
- Children & Elderly: Use with caution in children and elderly patients. Not recommended for postmenopausal women.
- Lifestyle Considerations: Avoid alcohol during treatment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Citrus Bioflavonoid + Ethamsylate + Menadione + Tribasic Calcium Phosphate?
A: Dosage varies significantly depending on the specific brand and the patient’s condition. Always refer to the prescribing information or consult a doctor for precise guidance.
Q2: Can this combination be used during pregnancy?
A: It is generally contraindicated during pregnancy due to potential fetal risks. Consult a doctor before use.
Q3: What are the common side effects?
A: Common side effects include headache, nausea, rash, fatigue, stomach pain, muscle or joint pain, diarrhea, nasal congestion, and sinus pain.
Q4: Are there any serious side effects I should be aware of?
A: Rare but serious side effects include allergic reactions, thromboembolic events, and hypercalcemia. Seek immediate medical attention if these occur.
Q5: How does this combination interact with other medications?
A: It may interact with anticoagulants, hormonal contraceptives, other calcium supplements, and certain leukemia medications. Inform your doctor about all other medications you are taking.
Q6: Can this combination be used in children?
A: Safety and efficacy in children haven’t been fully established. Use with caution in adolescents under 18, under strict medical supervision.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. However, if it’s close to the time for your next dose, skip the missed dose and return to your regular schedule. Do not double the dose to catch up.
Q8: Is it safe to take this combination with alcohol?
A: Alcohol may increase the risk of gastrointestinal side effects. It’s generally advisable to avoid alcohol during treatment.
Q9: How should I store this medication?
A: Store at room temperature, away from moisture and direct sunlight. Keep out of reach of children.
Q10: What are the monitoring parameters for this drug?
A: Liver function tests, coagulation profile, and calcium levels should be monitored during treatment, especially in patients with pre-existing conditions or prolonged use.
