📋 Clinical Overview

A fixed-dose combination (FDC) of an antifibrinolytic agent (Tranexamic Acid) and a non-steroidal anti-inflammatory drug (NSAID) of the fenamate class (Mefenamic Acid). It is primarily indicated for the management of heavy menstrual bleeding (menorrhagia) associated with pain and inflammation, providing a dual mechanism of action to reduce bleeding and alleviate pain. The combination is widely used in the Indian context for dysmenorrhea and menorrhagia.

💊 Dosage & Administration

Adult: 1 tablet (Tranexamic Acid 500mg + Mefenamic Acid 250mg) three times daily, starting at the onset of menses. Duration typically 3-5 days, not to exceed 5 days per menstrual cycle.

Note: Take with or immediately after food with a full glass of water to minimize gastric irritation. Do not crush or chew. Swallow whole. The tablet should be taken at evenly spaced intervals during the days of menstruation.

⚠️ Contraindications

Hypersensitivity to Tranexamic Acid, Mefenamic Acid, or any other NSAID/component
Active peptic ulcer disease or history of recurrent ulcer/bleeding
Severe renal failure (CrCl <30 mL/min)
History of or active thromboembolic disease (e.g., DVT, PE, stroke, MI)
Severe hepatic impairment (Child-Pugh Class C)
Inflammatory bowel disease (e.g., Crohn's, ulcerative colitis)
Concomitant use with other anticoagulants (e.g., warfarin, dabigatran) except under strict supervision
Third trimester of pregnancy

🔬 Mechanism of Action

The combination works synergistically. Tranexamic Acid competitively inhibits the activation of plasminogen to plasmin, thereby preventing the breakdown of fibrin clots and reducing menstrual blood loss. Mefenamic Acid inhibits the enzymes cyclooxygenase-1 and 2 (COX-1 & COX-2), leading to reduced synthesis of prostaglandins (especially PGE2 and PGF2α) which are mediators of pain, inflammation, and uterine hypercontractility in dysmenorrhea.

🤕 Side Effects

Nausea
Dyspepsia (indigestion, heartburn)
Abdominal pain
Diarrhea (more common with Mefenamic Acid)
Headache
Fatigue
Menstrual discomfort (paradoxical, if dose inadequate)

🤰 Special Populations

Pregnancy: Category C (US FDA). Avoid in first and second trimesters unless clearly needed. Contraindicated in third trimester due to risk of premature closure of ductus arteriosus in the fetus, oligohydramnios, and potential interference with labor. Tranexamic acid crosses placenta; use only if potential benefit justifies potential risk.

Driving: May cause dizziness, vertigo, or visual disturbances. Patients should not drive or operate machinery if affected.

🔄 Drug Interactions

Anticoagulants (Warfarin, Heparin, DOACs)	Increased risk of bleeding with Tranexamic Acid; increased risk of GI bleed with Mefenamic Acid. Conflicting effects require extreme caution.	Major
Anti-platelets (Aspirin, Clopidogrel)	Increased risk of gastrointestinal bleeding and ulceration.	Major
Other NSAIDs (Ibuprofen, Diclofenac)	Increased risk of GI toxicity (ulcers, bleeding) and renal impairment.	Major
Corticosteroids (Prednisolone)	Increased risk of GI ulceration and bleeding.	Major
ACE Inhibitors (Ramipril, Enalapril) / ARBs (Losartan)	Mefenamic Acid may reduce antihypertensive effect and increase risk of renal impairment.	Moderate
Diuretics (Furosemide, Hydrochlorothiazide)	Reduced diuretic and antihypertensive efficacy; risk of renal failure.	Moderate
Lithium	Mefenamic Acid can increase lithium serum levels, risking toxicity.	Major
Methotrexate	Mefenamic Acid may increase methotrexate toxicity.	Major
Selective Serotonin Reuptake Inhibitors (SSRIs e.g., Sertraline)	Increased risk of upper gastrointestinal bleeding.	Moderate

🔁 Alternatives to Cosklot MF

Same composition (Tranexamic Acid (500mg) + Mefenamic Acid (250mg)), different brands:

Tranexa M Pause M Styptovit M Trapic MF