A fixed-dose combination (FDC) analgesic, anti-inflammatory, and antifibrinolytic agent. Mefenamic acid provides NSAID-based pain relief and anti-inflammatory action. Tranexamic acid is an antifibrinolytic that reduces bleeding by inhibiting plasminogen activation. Vitamin K (as Menadione Sodium Bisulfite) supports coagulation factor synthesis. This combination is primarily indicated for the management of heavy menstrual bleeding (menorrhagia) associated with pain and dysmenorrhea, offering a synergistic approach to reduce both bleeding and pain.
Adult: 1 tablet three times daily, starting at the onset of menstrual bleeding or pain. Do not exceed 3 tablets per day. Duration of treatment should not exceed 4-5 days per menstrual cycle.
Note: Take with or immediately after food with a full glass of water to minimize gastrointestinal irritation. Do not crush or chew. Swallow whole. The tablet should be taken at the first sign of menstrual bleeding or pain. Do not use for more than the prescribed days per cycle.
Mefenamic Acid: Non-steroidal anti-inflammatory drug (NSAID) that reversibly inhibits both cyclooxygenase (COX-1 and COX-2) enzymes, leading to decreased synthesis of prostaglandins, thromboxanes, and prostacyclins from arachidonic acid. This reduces inflammation, pain, and fever. It also has prostaglandin antagonist activity at receptor sites. Tranexamic Acid: A synthetic derivative of the amino acid lysine. It competitively inhibits the activation of plasminogen to plasmin by binding to the lysine-binding sites on plasminogen. At higher concentrations, it non-competitively inhibits plasmin. This stabilizes clots by preventing fibrin degradation. Vitamin K (Menadione): Acts as a cofactor for the hepatic microsomal enzyme gamma-glutamyl carboxylase, which catalyzes the post-translational carboxylation of glutamic acid residues on vitamin K-dependent clotting factors (II, VII, IX, X) and proteins C and S. This carboxylation is essential for their calcium-binding and procoagulant activity.
Pregnancy: Pregnancy Category C (US FDA). Mefenamic Acid: Avoid in third trimester (risk of premature ductus arteriosus closure, oligohydramnios, delayed labor). Use in first and second trimester only if potential benefit justifies risk. Tranexamic Acid: Crosses placenta. Data limited; use only if clearly needed. Vitamin K: Generally safe, but high-dose menadione can cause kernicterus in neonates. OVERALL: Not recommended during pregnancy unless for a life-threatening hemorrhage under specialist care. This FDC is intended for menstruating women and should not be used if pregnancy is suspected.
Driving: May cause dizziness, vertigo, fatigue, or visual disturbances. Patients should be cautioned about driving or operating machinery if they experience these effects.
| Anticoagulants (Warfarin, Acenocoumarol) | Vitamin K antagonizes warfarin effect. Mefenamic acid increases bleeding risk via antiplatelet effect and ulcerogenic potential. TRANEXAMIC ACID INCREASES THROMBOSIS RISK. Contraindicated. | Contraindicated |
| Anti-platelets (Aspirin, Clopidogrel) | Increased risk of GI bleeding. Avoid concomitant use. | Major |
| Other NSAIDs (Ibuprofen, Diclofenac) | Increased risk of GI toxicity and renal impairment. Avoid combination. | Major |
| ACE Inhibitors (Ramipril, Enalapril) | Mefenamic acid reduces antihypertensive effect and increases risk of renal impairment. | Moderate |
| Diuretics (Furosemide, Hydrochlorothiazide) | Reduced diuretic efficacy. Increased risk of nephrotoxicity. | Moderate |
| Lithium | Mefenamic acid can increase lithium levels to toxic range. Monitor serum lithium. | Major |
| Methotrexate | Mefenamic acid may decrease renal clearance of methotrexate, increasing toxicity. | Major |
| Corticosteroids (Prednisolone) | Markedly increased risk of GI ulceration and bleeding. | Major |
| SSRIs (Fluoxetine, Sertraline) | Increased risk of upper GI bleeding. | Moderate |
| Oral Contraceptives | No significant interaction. Often used concomitantly for cycle regulation. | Minor |
| Antacids | May reduce absorption of mefenamic acid. Separate administration by 2 hours. | Minor |
| Probenecid | May increase mefenamic acid levels. | Moderate |
Same composition (Mefenamic Acid (250mg) + Tranexamic Acid (500mg) + Vitamin K (25mcg)), different brands: