COASTAT PLUS

Indications

• Menorrhagia
• Abnormal uterine bleeding
• Prevention of bleeding during surgical procedures
• Post-operative bleeding

Dosage

Children: Refer to the BNF for Children for specific dosing guidelines.

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Etamsylate enhances the stability of capillaries and reduces their permeability. It promotes platelet aggregation and has a role in the coagulation cascade, though its precise mechanism is not fully understood.

Pharmacodynamics

Etamsylate acts by stabilizing the endothelial cells of capillaries, which helps to prevent leakage of plasma proteins and fluid into tissues, thereby reducing bleeding. The drug has been shown to be effective in various clinical settings, particularly in managing heavy menstrual bleeding.

Pharmacokinetics

Etamsylate is rapidly absorbed after oral administration and reaches peak plasma concentrations within 1 to 3 hours. It is metabolized in the liver, with a significant portion excreted unchanged in urine. The elimination half-life of etamsylate is approximately 3 hours, allowing for flexible dosing schedules.

Adverse effects

• Gastrointestinal disturbances
• Allergic reactions
• Headache
• Dizziness

Precautions

• Use with caution in patients with a history of hypersensitivity to etamsylate or any of its components
• Monitor for signs of bleeding in patients with coagulopathies

Pregnancy

Etamsylate should only be used during pregnancy if the benefits outweigh the risks, as safety in human pregnancy has not been established.

Breast-feeding

Etamsylate is excreted in breast milk, and caution is advised when administering to nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Tablets
• Injectable solution

Indications

• Heavy menstrual bleeding (menorrhagia)
• Surgical procedures to reduce blood loss
• Trauma-related bleeding
• Hereditary angioedema
• Dental procedures in patients with bleeding disorders

Dosage

Children: Refer to the BNF for Children for specific dosing guidelines based on age, weight, and indication.

Adults: Refer to the BNF for specific dosing guidelines based on indication and patient condition.

Mechanism of action

Tranexamic acid competitively inhibits the lysine binding sites on plasminogen, preventing its conversion to plasmin. This inhibition decreases fibrinolysis, leading to increased clot stability and reduced bleeding.

Pharmacodynamics

The primary pharmacodynamic effect of tranexamic acid is its ability to reduce bleeding by stabilizing fibrin clots. The drug exhibits a dose-dependent effect on clotting, with higher doses leading to a more pronounced antifibrinolytic effect. Tranexamic acid does not significantly affect platelet function or coagulation factors.

Pharmacokinetics

Tranexamic acid is rapidly absorbed after oral administration, with peak plasma concentrations occurring within 1 to 3 hours. It has a bioavailability of approximately 30% to 50%. The drug is primarily excreted unchanged in the urine, with a half-life of approximately 2 hours. It does not undergo significant metabolism in the liver, which is beneficial in patients with hepatic impairment.

Contra-indications

• Active venous thromboembolism
• History of thromboembolic disorders
• Severe renal impairment
• Hypersensitivity to tranexamic acid or any excipients

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Dizziness
• Headache
• Visual disturbances
• Thrombosis
• Hypotension
• Allergic reactions

Interactions

• Anticoagulants (increased risk of thrombosis)
• Hormonal contraceptives (increased risk of thrombosis)
• Fibrinolytics (increased risk of bleeding)

Precautions

• Monitor for signs of thrombosis during treatment
• Use with caution in patients with a history of seizures
• Caution in patients with renal impairment
• Assess the risk of bleeding before use

Pregnancy

Tranexamic acid should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Tranexamic acid is excreted in breast milk; caution should be exercised when administered to nursing mothers.

Storage

Store at room temperature, away from moisture and direct sunlight. Keep out of reach of children.

Formulations

• Tablets
• Injection solution