Usage
Mefenamic Acid + Tranexamic Acid is primarily prescribed for the management of dysmenorrhea (painful menstruation) and menorrhagia (heavy menstrual bleeding). It can also provide relief from pain, fever, inflammation, and migraine headaches. This combination medication belongs to the pharmacological classifications of Nonsteroidal anti-inflammatory drugs (NSAIDs) and antifibrinolytics. Tranexamic acid, the antifibrinolytic component, works by inhibiting the breakdown of blood clots, thereby reducing bleeding. Mefenamic acid, the NSAID component, works by blocking the production of prostaglandins, which are chemical messengers that cause pain and inflammation.
Alternate Names
There are no widely recognized alternate names for the combination of Mefenamic Acid + Tranexamic Acid. Brand names may vary depending on the manufacturer and region. Some popular brand names include Osemic-MF and Adorefem.
How It Works
Pharmacodynamics: Tranexamic acid exerts its antifibrinolytic effect by reversibly blocking the lysine-binding sites of plasminogen, thereby preventing the formation of plasmin, an enzyme that breaks down fibrin. This action stabilizes blood clots and reduces bleeding. Mefenamic acid, as an NSAID, inhibits cyclooxygenase (COX) enzymes, primarily COX-1 and COX-2, reducing the production of prostaglandins responsible for pain, fever, and inflammation.
Pharmacokinetics: Both drugs are absorbed orally. Mefenamic acid reaches peak plasma concentrations in 2 to 4 hours, while tranexamic acid reaches peak levels in about 3 hours. Mefenamic acid is extensively metabolized in the liver, primarily by CYP2C9 enzymes, while tranexamic acid undergoes minimal metabolism. Tranexamic acid is predominantly excreted unchanged in the urine, whereas mefenamic acid is excreted in both urine and feces.
Dosage
Standard Dosage
Adults:
The standard dose is typically one tablet containing 500 mg of tranexamic acid and 250 mg of mefenamic acid, taken three times a day during menstruation, starting at the onset of bleeding and continuing for 3 to 4 days. Some guidelines suggest 1-2 tablets once or twice daily. The total daily dose should not exceed 4 grams of tranexamic acid or 1500 mg of mefenamic acid. It should be taken with food to minimize gastrointestinal upset.
Children:
The safety and efficacy of this combination have not been established in children below 14 years of age. For children 14 years and older, the adult dose may be used for dysmenorrhea. For other types of pain in those 14 and older, an initial dose of 500 mg followed by 250 mg every 6 hours as needed for up to one week. For younger children, the use and dose must be determined by a doctor.
Special Cases:
- Elderly Patients: Dose reduction may be necessary in elderly patients with renal impairment.
- Patients with Renal Impairment: Dose reduction is recommended for patients with renal impairment. For tranexamic acid, specific guidelines recommend dose reductions depending on the severity of the impairment.
- Patients with Hepatic Dysfunction: Dose adjustment may be needed in patients with hepatic dysfunction. Caution is advised.
- Patients with Comorbid Conditions: Close monitoring is recommended for patients with a history of blood clots, heart disease, or gastrointestinal problems.
Clinical Use Cases
The combination of Mefenamic Acid + Tranexamic Acid is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or intensive care units. Its primary use is for the management of menorrhagia and dysmenorrhea. Tranexamic acid alone is sometimes used to reduce blood loss during certain surgical procedures.
Dosage Adjustments
Dose adjustments are necessary based on patient-specific factors like renal or hepatic dysfunction. No specific guidelines exist for mefenamic acid dose adjustments in hepatic impairment, but caution is advised. For tranexamic acid, dose adjustments are based on creatinine clearance levels.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, indigestion, heartburn, headache, dizziness, muscle pain, stomach pain.
Rare but Serious Side Effects:
Blood clots, allergic reactions (including anaphylaxis), seizures, visual disturbances, severe gastrointestinal bleeding, acute renal failure.
Long-Term Effects:
Long-term use of NSAIDs like mefenamic acid can increase the risk of cardiovascular events and gastrointestinal complications. Long-term use of tranexamic acid may increase the risk of thromboembolic events.
Adverse Drug Reactions (ADR):
Any signs of blood clots (e.g., chest pain, shortness of breath, swelling or pain in the legs), severe allergic reactions, visual disturbances, severe gastrointestinal bleeding, or seizures require immediate medical attention.
Contraindications
- Hypersensitivity to either mefenamic acid or tranexamic acid.
- Active thromboembolic disease (e.g., deep vein thrombosis, pulmonary embolism).
- History of thromboembolic events or intrinsic risk factors for thrombosis.
- Severe renal impairment.
- Consumption coagulopathy (except when predominant activation of the fibrinolytic system with acute severe bleeding).
- History of seizures.
- Acquired color vision disturbances.
- Concomitant use with combined hormonal contraceptives.
- Severe heart failure.
- Third trimester of pregnancy.
Drug Interactions
- Anticoagulants (e.g., warfarin, heparin): Increased risk of bleeding.
- Antiplatelet agents (e.g., aspirin, clopidogrel): Increased risk of bleeding.
- NSAIDs (e.g., ibuprofen, naproxen): Increased risk of gastrointestinal bleeding and renal dysfunction.
- Other medications metabolized by CYP2C9: Potential for altered drug levels.
- Alcohol: Increased risk of drowsiness, dizziness, and stomach bleeding.
Pregnancy and Breastfeeding
- Pregnancy: Use is generally not recommended during pregnancy, especially in the third trimester. Mefenamic acid should not be used starting at 20 weeks. Tranexamic acid can be used if necessary, and benefits outweigh the risks. Consult a doctor before use.
- Breastfeeding: Both drugs are excreted in breast milk in small amounts. Although generally considered safe, some infants may experience restlessness or other side effects. Monitor the infant for any adverse effects. Alternatives may be preferred.
Drug Profile Summary
- Mechanism of Action: Tranexamic acid: Antifibrinolytic, inhibits plasmin formation. Mefenamic acid: NSAID, inhibits COX enzymes.
- Side Effects: Nausea, vomiting, diarrhea, headache, dizziness, gastrointestinal issues, potential for blood clots.
- Contraindications: Active thromboembolic disease, severe renal failure, hypersensitivity, pregnancy (third trimester).
- Drug Interactions: Anticoagulants, NSAIDs, alcohol.
- Pregnancy & Breastfeeding: Consult a doctor before use during pregnancy or breastfeeding.
- Dosage: Adults: One tablet (500 mg tranexamic acid + 250 mg mefenamic acid) three times daily during menstruation for 3-4 days or 1-2 tablet once or twice a day.
- Monitoring Parameters: Signs of blood clots, bleeding, renal function, liver function.
Popular Combinations
This combination itself is a popular combination for managing menorrhagia and dysmenorrhea. There are no other commonly recommended drug combinations with this specific combination.
Precautions
- General Precautions: Evaluate renal and hepatic function before initiating therapy.
- Specific Populations: Consult a doctor before use during pregnancy and breastfeeding. Use not recommended for children under 14 years.
- Lifestyle Considerations: Avoid alcohol during treatment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Mefenamic Acid + Tranexamic Acid?
A: The usual adult dose is one tablet (500 mg tranexamic acid + 250 mg mefenamic acid) three times daily during menstruation, starting at the onset of bleeding for 3-4 days. Some guidelines recommend one to two tablets once or twice daily, not exceeding 4000 mg tranexamic acid or 1500 mg mefenamic acid per day. Pediatric use has not been established in patients younger than 14 years. Those 14 and older may use the adult dose.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, indigestion, heartburn, headache, and dizziness.
A: Blood clots (chest pain, shortness of breath, leg swelling or pain), severe allergic reactions, seizures, visual disturbances, and severe gastrointestinal bleeding require immediate medical attention.
Q4: Can I take this medication if I am pregnant or breastfeeding?
A: Consult a doctor before using this medication during pregnancy or breastfeeding. Use is generally not recommended during pregnancy, especially in the third trimester. For tranexamic acid, if needed, benefits should outweigh the risks. It is excreted in breast milk in small amounts, and while generally considered safe during breastfeeding, monitor the infant for potential side effects.
Q5: What medications should I avoid while taking Mefenamic Acid + Tranexamic Acid?
A: Avoid other NSAIDs (aspirin, ibuprofen, naproxen), anticoagulants (warfarin, heparin), and alcohol.
Q6: What are the contraindications for this combination?
A: Contraindications include active thromboembolic disease, severe renal impairment, hypersensitivity to either component, history of seizures, current use of combined hormonal contraceptives, and the third trimester of pregnancy.
Q7: How does this combination work to reduce heavy menstrual bleeding and pain?
A: Tranexamic acid inhibits the breakdown of blood clots, reducing bleeding, while mefenamic acid inhibits prostaglandin production, reducing pain and inflammation.
Q8: Are there any long-term risks associated with this medication?
A: Long-term use of NSAIDs like mefenamic acid may increase the risk of cardiovascular events and gastrointestinal complications. Long-term use of tranexamic acid may increase the risk of thromboembolic events. Consult with a doctor if the medicine must be taken longer than recommended.
Q9: Should I take this medicine on an empty stomach?
A: No, it’s recommended to take this medication with food to reduce the risk of stomach upset.
Q10: Can I drink alcohol while using this medicine?
A: No. Avoid alcohol while taking this medication, as it can increase the risk of drowsiness, dizziness, and stomach bleeding.
