Mefanamic acid enhances activity of oralanticoagulants but rarely significant Increases risk of GI irritation with alcohol. Tranexamic acid has increased risk of thrombus formation with oestrogens

Primary dysmenorrhea

Diarrhea, nausea, vomiting, vision,giddiness,hypotension, thromboembolism, and thrombosis Bronchiospasm, headache, drowsiness, insomnia, visual disturbances, urticaria, rash, Thrombocytopenia, aplastic anemia, agranulcytosis, Autoimmune haemolytic anemia, convulsions (overdosage) with mefanamic acid

Sevee renal failure, thromboembolitic disease, massive upper respiratory tract haemorrhage, pronounced thrombotic tendency or color vision disorders

Special precautions-

Mild to moderate renal impairment, long term treatment of heriditary angioedema, Urethral obstruction, previous history of thromboembolic disease, Concurent admin. with Factor IX complex concentrates or anti-inhibitor coagulant concentrates Throaic or abdominal surgery,

Dissemnated intravascular (DIC ), haematuria, Active intravascular clotting, Asthma Monitor blood counts during long term therapy Drowsiness may affect ability to perform skilled jobs

Short term treatment of haemorrhage

Dosage- 1 tablet bid or tid

Pharmacokinetics-

Tranexamic acid is an antifibrinolytic agent competitively inhibits conversion of plasminogen to plasmin, hence prevents breakdown of clot. It increases collagen synthesis which preserves the fibrin matrix and increase the tensile strength of the clot. Mefanmic acid inhibits the enzyme cyclooxygenase and reduces the formation of prostaglandins . Leukotrients may also be reduced. Mefanamic acid also acts as an antagonist at prostaglandin receptor sites.

Pharmacokinetics-

Tranexamic acid absoprtion after oral administration is 30- 50% Food has no influence on absorption. Plasma half-life is 1.4h. It is mainly eliminated unchanged in the urine. Mefanamic acid is absorbed from the GI tract .Peak plasma concentrations occur about 2 to 4 hours after ingestion.

The plasma elimination half-life is reported to be 2 to 4 hours. Mefanamic acid is extensively bound to plasma proteins.

Rationale for combination-

Tranexamic acid plasmogen activator inhibitor, inhibits the level of plasminogen activators. Mefanamic acid a PG synthetase inhibitor,thought to act by reducing uterine prostaglandin levels such as PGE2 and PG12 whic are elevated in women with excessive menstrual bleeding. A combination of mefanamic acid and tranexamic acid will be beneficial in patients with menorrhagia and menorrhigia with dysmenorhea

Food has no influence onabsorption.

Caution to be excercised while using during pregnancy and lactation.