Usage
- This drug combination is prescribed primarily to manage heavy menstrual bleeding (menorrhagia). Secondary uses include treating nosebleeds, and potentially for hemorrhage in hemophilia patients, postpartum hemorrhage, melasma, hyperpigmentation, and chronic venous insufficiency.
- Pharmacological Classification: Anti-hemorrhagic, antifibrinolytic, antioxidant.
- Mechanism of Action: Tranexamic acid, an antifibrinolytic, inhibits the breakdown of blood clots, thereby reducing bleeding. Pine bark extract, a source of proanthocyanidins, acts as an antioxidant and anti-inflammatory agent, supporting vascular health.
Alternate Names
- No widely recognized alternate generic names.
- Brand names: Depishine-TX, Tranesma Plus, Tranaclear Plus, Pinodin-TX, Misma TX. (Note: Brand names can vary regionally).
How It Works
- Pharmacodynamics: Tranexamic acid competitively inhibits the breakdown of fibrin clots by blocking the binding of plasminogen and plasmin to fibrin. This prevents the dissolution of blood clots and reduces bleeding. Pine bark extract, rich in proanthocyanidins, exhibits antioxidant and anti-inflammatory properties, protecting blood vessel walls and enhancing blood flow.
- Pharmacokinetics: Tranexamic acid is absorbed orally and excreted primarily through the kidneys. Pine bark extract’s pharmacokinetics are not fully characterized but it is thought to have good bioavailability and to be metabolised by the liver.
- Mode of Action: Tranexamic acid’s mode of action is enzyme inhibition (plasmin inhibition). Pine bark extract’s mode of action is primarily antioxidant and anti-inflammatory, potentially influencing various pathways.
- Elimination pathways: Tranexamic acid is primarily eliminated via renal excretion. Pine bark extract’s elimination pathways are less well-defined but likely involve hepatic metabolism and subsequent excretion.
Dosage
Standard Dosage
Adults:
- For heavy menstrual bleeding: Tranexamic acid 250-500 mg combined with pine bark extract 50 mg, two to three times daily, typically for up to four or five days per menstrual cycle. Specific dosing regimens should consider brand-specific formulations.
Children:
- Use in children is generally not recommended, except in cases of bleeding disorders and hereditary angioedema after careful risk/benefit analysis by a physician. Dosage would need to be weight-based and determined by the doctor.
Special Cases:
- Elderly Patients: Caution advised, particularly with renal impairment. Dose adjustments may be necessary.
- Patients with Renal Impairment: Dose reductions may be needed based on the degree of impairment.
- Patients with Hepatic Dysfunction: Caution advised. Dosage modifications may be necessary.
- Patients with Comorbid Conditions: Consider potential interactions and adjust dose as needed. Specifically, use caution in patients with a history of thrombosis or clotting disorders.
Clinical Use Cases
- This specific drug combination (pine bark extract + tranexamic acid) does not have established dosage recommendations for settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Tranexamic acid alone is frequently used in certain surgical and trauma settings, at the discretion of the physician, and intravenous administration is common in these cases.
Dosage Adjustments
- Dose modification should be considered in renal/hepatic dysfunction and other relevant comorbidities.
Side Effects
Common Side Effects
- Nausea, diarrhea, itchy skin, headache.
Rare but Serious Side Effects
- Allergic reactions (difficulty breathing, swelling), vision changes, signs of blood clots (chest pain, leg pain, shortness of breath), seizures.
Long-Term Effects
- Limited data on long-term effects of combined use.
Adverse Drug Reactions (ADR)
- Severe allergic reactions, thromboembolic events.
Contraindications
- Active intravascular clotting or thrombosis, hypersensitivity to tranexamic acid or pine bark extract, subarachnoid hemorrhage, severe renal impairment, impaired color vision. History of seizures.
Drug Interactions
- Limited information on drug-drug interactions for this specific combination. However, tranexamic acid may interact with hormonal contraceptives and clotting factors. It is important to inform the prescribing physician of all concomitant medications.
Pregnancy and Breastfeeding
- Safety during pregnancy and breastfeeding is not fully established. Use only if benefits outweigh risks. Tranexamic acid may be present in breast milk in small amounts.
Drug Profile Summary
- Mechanism of Action: Tranexamic acid: antifibrinolytic; Pine bark extract: antioxidant, anti-inflammatory.
- Side Effects: Nausea, diarrhea, itchy skin, headache (common); allergic reactions, vision changes, blood clots, seizures (rare).
- Contraindications: Thromboembolic disease, hypersensitivity, subarachnoid hemorrhage, severe renal impairment.
- Drug Interactions: Limited information for this combination, but monitor for interactions with hormonal contraceptives and clotting factors.
- Pregnancy & Breastfeeding: Caution advised; use only if benefits outweigh risks.
- Dosage: Adult: 250-500 mg tranexamic acid + 50 mg pine bark extract, two to three times daily (for menorrhagia). Pediatric use: not routinely recommended, only in certain cases after careful consideration.
- Monitoring Parameters: Bleeding, signs of thrombosis, renal function (if applicable).
Popular Combinations
- This particular combination of pine bark extract and tranexamic acid is itself a common combination, often found in fixed-dose formulations. The rationale is to combine the anti-bleeding effect of tranexamic acid with the potential vascular-supporting and anti-inflammatory benefits of pine bark extract.
Precautions
- General Precautions: Assess for allergies, renal/hepatic function, history of thrombosis.
- Specific Populations: Pregnancy/breastfeeding: use with caution. Children/Elderly: dose adjustments often necessary.
- Lifestyle Considerations: Limited information on interactions with alcohol or smoking specifically for this combination.
FAQs (Frequently Asked Questions)
A: Typical adult dosages are 250-500mg tranexamic acid + 50 mg Pine Bark Extract, taken two or three times daily for up to four or five days during menstruation. Dosages may vary depending on the formulation. Always consult a doctor for the right dosage.
Q2: How does this combination differ from tranexamic acid alone?
A: The addition of pine bark extract may provide antioxidant and anti-inflammatory support for vascular health, which could complement the antifibrinolytic action of tranexamic acid.
Q3: Can this combination be used during pregnancy?
A: Safety during pregnancy isn’t fully established. Use only if the doctor determines benefits outweigh risks.
Q4: What are the major side effects to watch out for?
A: Common side effects include nausea, diarrhea, and itchy skin. Rare but serious effects include allergic reactions, changes in vision, and signs of blood clots.
Q5: Are there any specific dietary restrictions while on this medication?
A: No specific dietary restrictions have been identified for this combination.
Q6: Can this medication interact with other drugs I’m taking?
A: Potential drug interactions with hormonal contraceptives and clotting factors exist. Always inform your doctor about all other medications you’re using.
Q7: How long should treatment with this medication continue?
A: For heavy menstrual bleeding, treatment is typically limited to a few days (four or five) per menstrual cycle. For other conditions, the duration should be determined by a physician.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s almost time for your next dose. Do not double the dose.
Q9: Is this combination effective for all types of bleeding disorders?
A: It is primarily used for heavy menstrual bleeding and nosebleeds. Effectiveness for other bleeding disorders should be determined by a physician.
Q10: Can I drive while taking this medication?
A: In some cases, the drug combination may cause dizziness or blurred vision, which could impact the ability to drive safely. It is advisable to refrain from driving if you experience these side effects.
