Usage
- This combination drug is primarily prescribed for managing heavy menstrual bleeding (menorrhagia). It may also be used to control excessive bleeding post-surgery.
- Pharmacological classification: Antifibrinolytic, Hemostatic agent. Citrus bioflavonoids and calcium phosphate contribute to overall blood and bone health, menadione supports blood clotting, and tranexamic acid is an antifibrinolytic.
- Mechanism of action: This combination works synergistically to reduce bleeding. Tranexamic acid inhibits the breakdown of blood clots. Calcium phosphate provides calcium, which is crucial for blood clotting. Citrus bioflavonoids help maintain blood vessel integrity. Menadione (vitamin K3) is vital for synthesizing clotting factors.
Alternate Names
While there isn’t a universally recognized international non-proprietary name (INN) for this specific combination, the components have individual INNs as mentioned above.
- Brand names: Pause-XT, Stalia-Plus, Tenxima XT Stop, Hemsyl Cvp (and others)
How It Works
- Pharmacodynamics: Tranexamic acid inhibits plasminogen activation, reducing fibrinolysis and stabilizing clots. Calcium supports the clotting cascade. Citrus bioflavonoids improve capillary integrity. Menadione, a fat-soluble vitamin, is essential for synthesizing clotting factors II, VII, IX, and X in the liver.
- Pharmacokinetics:
- Tranexamic Acid: Well-absorbed orally. Primarily excreted renally.
- Citrus Bioflavonoids: Absorption and metabolism can vary.
- Menadione: Absorbed in the gastrointestinal tract. Metabolized in the liver. Excreted in urine and bile.
- Tribasic Calcium Phosphate: Absorption is influenced by vitamin D and other factors. Calcium is primarily excreted in urine.
- Mode of Action: Tranexamic acid acts by reversibly binding to plasminogen, preventing the formation of plasmin, an enzyme that breaks down fibrin in clots. Menadione acts as a cofactor for gamma-glutamyl carboxylase, an enzyme needed to form active blood clotting factors.
- Elimination pathways: Tranexamic acid and calcium are predominantly excreted renally. Menadione and its metabolites are excreted in bile and urine. Citrus bioflavonoids have variable excretion pathways.
Dosage
Standard Dosage
Adults: One tablet two to three times a day, preferably with food. This can vary between brands. The duration of treatment depends on the indication.
Children: Not generally recommended for premenarcheal girls. Use cautiously in adolescent females below 18 years, with dosage adjusted based on the child’s weight and the specific condition.
Special Cases:
- Elderly Patients: No specific dosage adjustment is usually necessary, but careful monitoring is recommended due to the potential for age-related decline in renal function.
- Patients with Renal Impairment: Dose adjustment may be required, especially with tranexamic acid, which is primarily renally cleared. Consult current guidelines.
- Patients with Hepatic Dysfunction: Caution advised, particularly with menadione due to its hepatic metabolism.
- Patients with Comorbid Conditions: Patients with bleeding disorders, clotting disorders, or history of thromboembolic events should be monitored carefully.
Clinical Use Cases
Specific dosage guidelines for clinical use cases such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations for this combination drug haven’t been found as of the current date (2025-02-16).
Dosage Adjustments
Dose adjustments are necessary for renal and hepatic impairment. Consider individual patient factors, concomitant medications, and clinical response for optimal dosing.
Side Effects
Common Side Effects
Headache, stomach pain, nasal congestion, sinus pain, sinus inflammation, rash, tiredness, musculoskeletal pain, anemia, fatigue, nausea, diarrhea.
Rare but Serious Side Effects
Allergic reactions, thromboembolic events (blood clots), elevated calcium levels.
Long-Term Effects
Long-term effects haven’t been extensively studied for this combination drug, especially given its typical use in managing acute conditions. However, long-term use of tranexamic acid may increase the risk of thromboembolic events in susceptible individuals.
Adverse Drug Reactions (ADR)
Severe allergic reactions, visual disturbances, seizures (rare).
Contraindications
Active or history of thromboembolic disease (e.g., deep vein thrombosis, pulmonary embolism), known allergy to any component, intracranial bleeding, severe renal impairment, defective color vision (for monitoring toxicity), active bleeding or clotting disorders, Subarachnoid hemorrhage, Thrombogenic valvular disease, thrombogenic cardiac rhythm disease, or hypercoagulopathy. Pregnancy.
Drug Interactions
- Hormonal contraceptives: May increase the risk of thrombosis.
- Anticoagulants (e.g., warfarin): May reduce the efficacy of tranexamic acid.
- Thrombolytic agents (e.g., streptokinase): Counteract the effects of tranexamic acid.
- Certain chemotherapy drugs (e.g., cyclophosphamide): May increase calcium release from cells. Alcohol should be avoided.
Pregnancy and Breastfeeding
- Pregnancy: This combination is contraindicated during pregnancy due to the risk of clotting complications and limited safety data.
- Breastfeeding: Caution advised, as tranexamic acid may be present in breast milk.
Drug Profile Summary
- Mechanism of Action: See above.
- Side Effects: See above.
- Contraindications: See above.
- Drug Interactions: See above.
- Pregnancy & Breastfeeding: Contraindicated in pregnancy, caution advised during breastfeeding.
- Dosage: See above.
- Monitoring Parameters: Blood clotting parameters, calcium levels, liver function (if indicated).
Popular Combinations
Specific data on popular combinations hasn’t been found as of the current date. This combination itself is designed to address bleeding by combining ingredients with complementary mechanisms.
Precautions
See contraindications and drug interactions. Monitor patients for side effects. Ensure adequate hydration. Renal function should be assessed in those with renal impairment. Exercise caution in patients with a history of blood clots, kidney disease, or hypercalcemia. Avoid in pregnant women.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Citrus Bioflavonoid + Menadione + Tranexamic Acid + Tribasic Calcium Phosphate?
A: The typical adult dosage is one tablet two to three times a day with meals. Dosage adjustments may be needed for children, elderly patients, and those with renal or hepatic impairment.
Q2: What are the common side effects?
A: Common side effects include headache, stomach upset, nasal congestion, and musculoskeletal pain.
Q3: Is this medication safe during pregnancy?
A: No, this combination is contraindicated during pregnancy.
Q4: Can I breastfeed while taking this medication?
A: Consult with a doctor, as caution is advised due to the potential for tranexamic acid to be present in breast milk.
Q5: How does tranexamic acid work to control bleeding?
A: Tranexamic acid prevents the breakdown of blood clots by inhibiting plasminogen activation.
Q6: What is the role of citrus bioflavonoids in this combination?
A: They contribute to vascular health and capillary integrity, potentially reducing bleeding.
Q7: How does menadione contribute to reducing bleeding?
A: Menadione (vitamin K3) is essential for producing blood clotting factors.
Q8: What is the purpose of calcium phosphate in this drug?
A: It supplies calcium, a crucial mineral for blood clotting, and promotes bone health.
Q9: What are the contraindications for using this medication?
A: Active or history of thromboembolic disease, known allergy to any component, intracranial bleeding, and severe renal impairment are major contraindications.
Q10: Are there any drug interactions I should be aware of?
A: Yes, this medication can interact with hormonal contraceptives, anticoagulants, and certain chemotherapy drugs. Consult with a healthcare professional before starting treatment if you have other existing medications.
