A fixed-dose combination product primarily indicated for the treatment of heavy menstrual bleeding (menorrhagia) and other bleeding disorders. Tranexamic acid is an antifibrinolytic agent that stabilizes clots. Tribasic Calcium Phosphate provides calcium for vascular integrity, Menadione (Vitamin K3) supports the synthesis of clotting factors, and Citrus Bioflavonoids (primarily hesperidin) are believed to strengthen capillary walls and reduce fragility. This combination aims to provide a multi-modal approach to managing bleeding by targeting fibrinolysis, coagulation factors, and vascular health.
Adult: For Menorrhagia: One tablet (Tranexamic Acid 500mg) two to three times daily, usually for 3-5 days during the menstrual period, starting from the day of heavy bleeding. Maximum duration per cycle should not exceed 5 days. The other components are fixed in the combination.
Note: Take with or after food to minimize gastrointestinal upset. Swallow whole with a full glass of water. Do not crush or chew. Maintain adequate hydration. Calcium absorption may be reduced by high-fiber diets, oxalates (spinach), and phytates (whole grains); space administration if possible.
Tranexamic Acid competitively inhibits the activation of plasminogen to plasmin, a fibrinolytic enzyme, by binding to the lysine-binding sites on plasminogen. This stabilizes fibrin clots. Tribasic Calcium Phosphate provides Ca2+ ions, essential for the coagulation cascade (specifically Factors IV, IX, X, and prothrombin). Menadione is a synthetic precursor to Vitamin K, which acts as a cofactor for hepatic gamma-glutamyl carboxylase, an enzyme necessary for the post-translational carboxylation of clotting factors II, VII, IX, and X, and proteins C and S, activating them. Citrus Bioflavonoids (e.g., hesperidin) exhibit antioxidant and anti-inflammatory properties and are thought to reduce capillary permeability and fragility, potentially supporting vascular integrity during bleeding episodes.
Pregnancy: Category B (for Tranexamic Acid). Not recommended unless clearly needed and potential benefit justifies potential risk to the fetus. Limited data on the combination. Avoid in first trimester unless for life-threatening hemorrhage.
Driving: May cause dizziness or visual disturbances. Patients should not drive or operate machinery if they experience these effects.
| Oral Contraceptives / Hormone Replacement Therapy (HRT) | Increased risk of thrombosis. Synergistic thrombotic risk. | Major |
| Other Anticoagulants (Warfarin, NOACs, Heparin) | Antagonizes the effect of anticoagulants. Reduced INR with warfarin. Increased risk of clotting if Tranexamic acid overrides anticoagulant. | Major |
| Tretinoin (All-Trans Retinoic Acid) | Increased risk of thrombosis with concomitant Tranexamic Acid. | Major |
| Tetracycline / Quinolone Antibiotics | Calcium can chelate these antibiotics, significantly reducing their absorption. Administer at least 2-3 hours apart. | Moderate |
| Bisphosphonates (e.g., Alendronate) | Calcium interferes with absorption. Administer at different times of the day. | Moderate |
| Levothyroxine | Calcium can impair its absorption. Administer at least 4 hours apart. | Moderate |
| Digoxin | Hypercalcemia can potentiate digoxin toxicity (arrhythmias). Monitor calcium levels and digoxin toxicity signs. | Moderate |
| Thiazide Diuretics | Increase renal calcium reabsorption, risk of hypercalcemia. | Moderate |
| Vitamin K Antagonists (Warfarin) | Menadione can reverse the anticoagulant effect of warfarin, lowering INR. | Major |
Same composition (Tranexamic Acid (500mg) + Tribasic Calcium Phosphate (144mg) + Menadione (20mcg) + Citrus Bioflavonoid (150mg)), different brands: