Now That’s Patience.

This is decidedly the month for blogs based upon reader questions. As usual, I first must remind you that I am not a doctor and you need to speak with yours before you take any action. As you know, I had major surgery in September to remove a pancreatic cancer tumor which included removing part of the pancreas, the gall bladder, and the spleen. Since then I’ve been hospitalized twice for complications of this surgery… and this particular reader has waited all this time for answers to her questions. I’m impressed.

Let’s not make her wait one second longer. She is a woman in her 40s who has questions about Chronic Kidney Disease and the menstrual period. Hey, guys, don’t go anywhere. Read today’s blog and you just might be able to offer some insight to your female CKD patient friends who have similar questions.

It seems her period went on and on… for two weeks. Her doctor (not a nephrologist) ordered medications for her, but she wasn’t sure if they were safe for her kidneys. In her country, you cannot simply make an appointment or call your nephrologist. You need to wait, and wait, and wait until you are given an appointment. Of course, her first course of these medications is now long over, but perhaps we can help her if she’s ever in this situation again… or if you are.

The first medication prescribed was Traxan. Don’t worry if that doesn’t ring a bell; I’d never heard of any of these medications before either. According to Drugs.com at https://www.drugs.com/international/traxan.html,

Traxan

Traxan may be available in the countries listed below.

Ingredient matches for Traxan

Tranexamic Acid

Tranexamic Acid is reported as an ingredient of Traxan in the following countries:

  • Philippines”

which makes sense since this particular reader is from the Philippines. This doesn’t tell us much, so let’s try Tranexamic Acid.

WebMD at https://www.webmd.com/drugs/2/drug-32677-1331/tranexamic-acid-oral/tranexamic-acid-650-milligram-tablet-oral/details offers the following information:

“This medication is used to treat heavy bleeding during your menstrual period. Tranexamic acid works by slowing the breakdown of blood clots, which helps to prevent prolonged bleeding. It belongs to a class of drugs known as antifibrinolytics.

Tranexamic acid is not a hormone. It does not treat other menstrual or premenstrual symptoms. It does not stop your period. It is not a form of birth control and does not protect against sexually transmitted diseases.”

And now the biggie: Is this safe if you have CKD? There is not much research on this other than a study with a very small population of only four patients. They did suffer adverse reactions, but three were on dialysis and the fourth had a transplant. The take away from over an hour’s search is that the dosage may have to be modified.

Mefenamic Acid was the second drug prescribed. By the way, the brand name for this drug is Ponstel.

“Mefenamic acid is used to relieve mild to moderate pain, including menstrual pain (pain that happens before or during a menstrual period). Mefenamic acid is in a class of medications called NSAIDs. It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.”

This information was offered by Medline Plus, part of the U.S. National Library of Medicine, which in turn is part of the National Institutes of Health at https://medlineplus.gov/druginfo/meds/a681028.html.

Houston, we have a problem. NSAIDS are something all kidney patients should avoid. I was delighted to happen upon the Curbsiders (a board-certified internists’ group) at https://thecurbsiders.com/podcast/146-nephmadness-pain-meds-in-chronic-kidney-disease who explained the NSAID problem in terms I (and hopefully you) can understand:

NSAIDs in CKD

Mechanism

  • NSAIDs work by inhibiting cyclooxygenase (COX) and thus decreasing prostaglandin synthesis. This reduces the inflammation causing pain.
  • Renal blood flow, particularly in CKD, often depends on prostaglandins and can decrease with NSAID use.
  • Heart failure, cirrhosis, nephrotic syndrome have low effective renal blood flow which relies on prostaglandins. In these patients, NSAIDs may decrease the eGFR.
  • When close to ESRD, you run the risk that a transient decrease in blood flow may still cause an issue…possibly knocking patients onto dialysis.
  • If a patient is already on dialysis and anuric, the adverse effects of NSAIDs are less significant. For those patients still making urine, there are still renal risks.”

Well, what about Mefenamic acid and CKD? Healthline (I simply cannot stop thanking you for those two best kidney disease blog awards!) at https://www.healthline.com/health/mefenamic-acid-oral-capsule#dosage makes no bones about it:

For people with kidney problems: If you have kidney disease, your body might not be able to clear out this drug as well as it should. This may cause increased amounts of mefenamic acid in your blood and increase your risk of side effects. Your doctor may prescribe a decreased dosage.”

Hopefully, a decreased dosage was prescribed.

And, finally, Marvelon. Forgive me, but I instantly thought of Marvel Comics. Actually, Marvelon is birth control. Oh, I wonder if my reader knew that and wanted birth control. Is it safe for CKD patients? Let’s find out together.

“Do not take this medication if you:

  • have diabetes with blood vessel complications (e.g., heart disease, eye disease, kidney disease, foot infections)
  • have very high cholesterol or triglyceride levels”

These are only two of the eighteen warnings I found on MedBroadcast at https://medbroadcast.com/drug/getdrug/marvelon This is a new site for me, so let me share what they have to say about themselves:

“Condition and disease information is written and/or reviewed by the MediResource Clinical Team. The contents of this site are for informational purposes only and are meant to be discussed with your physician or other qualified health care professional before being acted on. Never disregard any advice given to you by your doctor or other qualified health care professional. Always seek the advice of a physician or other licensed health care professional regarding any questions you have about your medical condition(s) and treatment(s).

This site is not a substitute for medical advice. © 1996 – 2020”

Thank you for being so patient, Philippine reader. Remember, talk to your doctor before doing anything.

Until next week,

Keep living your life!