Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Classification: Anti-fibrinolytic, antihemorrhagic Indications: Tranexamic acid is used for

the prompt and effective control of hemorrhage in various surgical and clinical areas: Treating heavy menstrual bleedingHemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) [...]

ARCOXIA is used for the following: to treat the symptoms of osteoarthritis to treat gout attacks to relieve short term pain, including cramp-like pain or discomfort before or during a menstrual period, and pain associated with minor dental procedures. Osteoarthritis Osteoarthritis is a joint disease. It results from the gradual breakdown of the cartilage that covers the joints and cushions the ends of bones. Symptoms of osteoarthritis include pain, tenderness, stiffness of one or more joints, and physical disability. The hips and knees are the most commonly affected joints, but other joints, such as those of the hands and spine, may also be affected. Osteoarthritis is more common in women than in men. Many factors can lead to the development of osteoarthritis, including obesity and joint injury (eg. from sport). Gout Gout is a disease that causes attacks of arthritis, usually in a single joint. The affected joint is red, swollen, painful and extremely tender. A gout attack usually lasts a few days and it may recur. For more information about osteoarthritis or gout, contact the Arthritis Foundation in the capital city of your state.

How ARCOXIA works

ARCOXIA belongs to a group of medicines called Coxibs. It works in a similar way to traditional anti-inflammatory medicines, known as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), by blocking the production of substances that cause pain and inflammation. In clinical trials, ARCOXIA has been shown to have a lower risk of serious side effects on the stomach (for example, bleeding stomach ulcers) than NSAIDs. Your doctor may have prescribed ARCOXIA for another reason. Ask your doctor if you have any questions about why ARCOXIA has been prescribed for you. The safety and effectiveness of ARCOXIA in children and teenagers under the age of 18 years have not been established. ARCOXIA is not addictive.

Before you take ARCOXIA

When you must not take it
Do not take ARCOXIA if: you have an allergy to ARCOXIA or any of the ingredients listed at the end of this leaflet you have taken aspirin or other anti-inflammatory medicines (commonly known as NSAIDs) before, which caused asthma, pinkish itchy swellings on the skin (hives), runny nose, or other allergic reactions

have had heart failure, a heart attack, bypass surgery, chest pain (angina), narrow or blocked arteries of the extremities (peripheral arterial disease), a stroke or mini stroke (TIA or transient ischaemic attack) if you have high blood pressure that has not been controlled by treatment (check with your doctor or nurse if you are not sure whether your blood pressure is adequately controlled) if you have serious liver disease if you have a current stomach ulcer or bleeding in your stomach or intestines if you have serious kidney disease Do not take ARCOXIA if: the packaging is torn or shows signs of tampering the expiry date on the pack has passed. If you take this medicine after the expiry date has passed, it may not work. If you are not sure whether you should start taking ARCOXIA, talk to your doctor.

Before you start to take it

Tell your doctor if: 1. you are pregnant or intend to become pregnant ARCOXIA is not recommended for use during late pregnancy. If there is a need to consider using ARCOXIA during your pregnancy, your doctor will discuss with you the benefits and risks of using it. 2. you are breast-feeding or plan to breast-feed It is not known if ARCOXIA passes into breast milk. You and your doctor should discuss whether you should stop breast-feeding or not take ARCOXIA. 3. you have or have had any medical conditions, especially the following: kidney disease liver disease asthma, hives, itching, or skin rash dehydration, for example by a prolonged bout of vomiting or diarrhea Inflammatory Bowel Disease heart failure high blood pressure heart attack, angina, or a blocked artery in your heart swelling of the ankles, feet or legs due to fluid retention (also called oedema) narrow or blocked arteries of the extremities stroke or mini stroke conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol, smoking or a first degree relative with ischemic heart disease

4. you have a history of ulcers or bleeding in your stomach or intestines 5. you have an infection If you take ARCOXIA while you have an infection, it may hide fever and may make you think, mistakenly, that you are better or that your infection is less serious than it might be. 6. you have any allergies to any other medicines or any other substances, such as foods, preservatives or dyes. If you have not told your doctor about any of the above, tell them before you take any ARCOXIA.

Taking other medicines

Tell your doctor if you are taking any other medicines, including medicines that you buy without a prescription from your pharmacy, supermarket or health food shop. Some medicines and ARCOXIA may interfere with each other. These include: warfarin, used to prevent blood clots ACE inhibitor and angiotensin receptor blocker medicines used to lower high blood pressure or treat heart failure some fluid tablets (diuretics) lithium, used to treat mood swings and some types of depressions methotrexate, used to treat arthritis and some types of cancer rifampicin, an antibiotic used to treat tuberculosis and other infections ethinyl oestradiol, used in some oral contraceptives ketoconazole, used to treat fungal infections conjugated estrogens, used in some hormone replacement therapies These medicines may be affected by ARCOXIA or may affect how well it works. You may need different amounts of your medicine, or you may need to take different medicines. If you are taking low-dose aspirin to help prevent a heart attack or stroke, do not stop taking it unless your doctor tells you to because ARCOXIA cannot replace the use of aspirin for this purpose. Some medicines should not be taken with ARCOXIA. These include: non-steroidal anti-inflammatory medicines (NSAIDs), used to relieve pain, swelling, and other symptoms of inflammation aspirin when used regularly for conditions other than to prevent heart attack or stroke. Your doctor or pharmacist has more information on medicines to be careful with or avoid while taking ARCOXIA.

How to take ARCOXIA

How much to take
Take ARCOXIA only when prescribed by your doctor.

For osteoarthritis, the recommended dose is 30mg once a day, increase to a maximum of 60mg once a day if needed. For the relief of gout attacks and short term pain, including menstrual pain and dental pain, the recommended dose is 120 mg taken once a day, which should only be used during the painful period. Doses greater than those recommended for each condition stated above have either not been shown to improve the effectiveness of ARCOXIA or have not been studied. Therefore, the daily doses stated above for each condition should not be exceeded. If you have mild liver disease, do not take more than 60 mg once a day. If you have moderate liver disease, do not take more than 60 mg every second day or 30mg once a day. Swallow ARCOXIA with a glass of water. Follow all directions given to you by your doctor carefully. They may differ from the information contained in this leaflet. If you do not understand the instructions on the box, ask your doctor or pharmacist for help.

When to take it
Take your ARCOXIA at about the same time each day. Taking ARCOXIA at the same time each day will have the best effect. It will also help you remember when to take the dose. It does not matter if you take ARCOXIA before, with or after food.

How long to take it

Depending on your condition, you may need to take ARCOXIA for a few days or for a longer period. For osteoarthritis ARCOXIA helps relieve your symptoms but it does not cure it. Continue taking ARCOXIA for as long as your doctor prescribes it. For the relief of gout attacks and short term pain, including menstrual pain and dental pain, ARCOXIA should only be used during the painful period, limited to a maximum of 8 days treatment. If you are not sure how long to take ARCOXIA, talk to your doctor.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, and then go back to taking your tablet(s) as you would normally. If you are not sure whether to skip the dose, talk to your doctor or pharmacist. Do not take a double dose to make up for the dose that you missed. If you have trouble remembering to take your tablets, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26), or go to accident and emergency at your nearest hospital, if you think that you or anyone else may have taken too much ARCOXIA. Do this even if there are no signs of discomfort or poisoning.

While you are using ARCOXIA

Things you must do
If you become pregnant while taking ARCOXIA, tell your doctor immediately. If you get an infection while taking ARCOXIA, tell your doctor. ARCOXIA may hide fever and may make you think, mistakenly, that you are better or that that your infection is less serious than it might be. If you notice any of the following, tell your doctor immediately: vomiting blood or material that looks like coffee grounds bleeding from the back passage, black sticky bowel motions (stools), or bloody diarrhoea These symptoms may occur at any time during use and without warning. any symptoms that could indicate a severe allergic reaction such as inability to breath or a serious skin reaction which may occur without warning You may need urgent medical attention. If any of the following symptoms: shortness of breath, chest pains or ankle swelling appear or worsen, stop your treatment with ARCOXIA and consult a doctor, as soon as is practical. If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking ARCOXIA. Additional things to be aware of while taking ARCOXIA: ARCOXIA works equally well in older and younger adult patients. Adverse experiences may occur at a higher incidence in older patients compared to younger patients. If you are elderly (i.e., over 65 years of age), your doctor will want to keep a regular check on you. No dosage adjustment is necessary for older patients. If you have kidney, liver or heart disease, your doctor will want to keep a regular check on you. Your doctor will want to discuss your treatment from time to time. It is important that you use the lowest dose that controls your pain and you should not take ARCOXIA for longer than necessary. This is because the risk of heart attacks and strokes might increase after prolonged treatment, especially with high doses. ARCOXIA can increase blood pressure in some people, especially in high doses, and this could increase the risk of heart attacks and strokes. Your doctor will want to check your blood pressure from time to time, to make sure that it is safe to continue treatment.

Things you must not do

Do not give ARCOXIA to anyone else, even if they have the same condition as you.

Things to be careful of
Be careful driving or operating machinery until you know how ARCOXIA affects you.

The effect of ARCOXIA on the ability to drive a car or operate machinery has not been studied, although it is thought to be unlikely to have any effect on these activities. However, as with many medicines, ARCOXIA may cause certain side effects in some people, including dizziness and tiredness. Make sure you know how you react to ARCOXIA before you drive a car or operate machinery.

Things that would be helpful for your osteoarthritis

Some self help measures suggested below may help your condition. Talk to your doctor or pharmacist about these measures and for more information. Exercise regular exercise can help reduce pain and disability from arthritis by increasing muscle strength and reducing the load on joints, but it is important not to overdo it. Walking is good exercise, however, before starting any exercise, ask your doctor about the best kind of programme for you. Weight your doctor may suggest losing some weight to help reduce the strain on your joints. Some people may need a dietician's help to lose weight. Hot and cold treatments these can help to relieve pain from arthritis, including hot and cold packs, or exercising in a warm water (hydrotherapy) pool. Talk to your doctor or physiotherapist about the types of hot and cold treatments available that would be helpful for your condition. Support devices and aids these may assist in coping with everyday tasks at home or help to relieve pain in certain joints. Ask a physiotherapist or occupational therapist for advice about joint protection, aids and special equipment.

Side Effects
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking ARCOXIA. ARCOXIA helps most people with arthritis, menstrual pain, or other types of pain, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects. Ask your doctor or pharmacist to answer any questions you may have. Tell your doctor if you notice or have any of the following and they worry you: feeling sick (nausea), vomiting heartburn, uncomfortable feeling in the stomach mouth ulcers diarrhoea swelling of the legs, ankles or feet high blood pressure headache, dizziness unusual tiredness or weakness difficulty sleeping depression

restlessness signs of urinary tract infection, including painful burning when passing urine high levels of potassium in your blood wheezing signs of an infection of the breathing passages, including runny nose, sore throat, cough feeling anxious confusion seeing, feeling or hearing things that are not there blurred vision These are the more common side effects of ARCOXIA. Tell your doctor immediately if you notice any of the following: skin rash or itchiness pinkish, itchy swellings on the skin, also called hives or nettlerash severe stomach pain passing little or no urine redness of the skin yellowing of the skin and/or eyes, also called jaundice a feeling of tightness, pressure or heaviness in the chest (angina) These may be serious side effects. Some of these may be symptoms of an allergic reaction to ARCOXIA. You may need urgent medical attention. If any of the following happen, tell your doctor immediately or go to accident and emergency at your nearest hospital: vomiting blood or material that looks like coffee grounds bleeding from the back passage, black sticky bowel motions (stools), or bloody diarrhoea swelling of the face, lips, mouth, throat or tongue which may cause difficulty in breathing or swallowing shortness of breath, wheezing, or trouble breathing fast or irregular heart beats rare skin condition with severe blisters and bleeding in the lips, eyes, mouth, nose and genitals liver disease with symptoms such as loss of appetite, yellowing of the skin and eyes, and dark coloured urine severe increase in blood pressure These may be serious side effects. You may need urgent medical attention. Other side effects not listed above may also occur in some patients. Tell your doctor if you notice any other effects. Do not be alarmed by this list of possible side effects. You may not experience any of them.

After using ARCOXIA

Storage
Keep your tablets in the blister pack until it is time to take them. If you take the tablets out of the blister pack, they may not keep well. Keep ARCOXIA in a cool dry place where the temperature stays below 30C. Do not store it or any other medicine in the bathroom or near a sink. Do not leave it in the car or on window sills.

Heat and dampness can destroy some medicines. Keep it where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal
If your doctor tells you to stop taking ARCOXIA or the tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.

Product description
What it looks like
ARCOXIA comes as three strengths of tablets: 30 mg tablet - blue-green, apple-shaped biconvex film coated tablet with 101 marked on one side and ACX 30 on the other. 60 mg tablet - dark green, apple-shaped biconvex film coated tablet with 200 marked on one side and ARCOXIA 60 on the other. 120 mg tablet - pale green, apple-shaped biconvex film coated tablet with 204 marked on one side and ARCOXIA 120 on the other. A box of ARCOXIA 30mg and 60 mg contains 30 tablets. A box of ARCOXIA 120 mg contains 10 tablets.

Ingredients
Active ingredient: ARCOXIA 30 mg tablet contains 30 mg etoricoxib ARCOXIA 60 mg tablet contains 60 mg etoricoxib ARCOXIA 120 mg tablet contains 120 mg etoricoxib Inactive ingredients: calcium hydrogen phosphate (anhydrous) microcrystalline cellulose lactose croscarmellose sodium hypromellose magnesium stearate carnauba wax titanium dioxide glycerol triacetate iron oxide yellow CI77492 (60 mg and 120 mg tablets) indigo carmine CI73015 (60 mg and 120 mg tablets)

Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Classification: Anti-fibrinolytic, antihemorrhagic Indications: Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) [...] Hemostan(tranexamic acid):

Pregnancy and Breastfeeding

The Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food, and Nutrition Board suggests that current calcium recommendations for non-pregnant women are also sufficient for pregnant women because intestinal calcium absorption increases during pregnancy. Pregnant women are especially vulnerable to accelerated bone turnover due to the physiologic stress of pregnancy and lactation. Studies indicate that pregnant women should take calcium supplements to prevent bone density loss. The National Academy of Sciences recommends that women who are pregnant or breastfeeding consume calcium each day. For pregnant teens, the recommended intake is higher. Consult a qualified healthcare professional to determine dosing during pregnancy and breastfeeding.

Journal
Treatment of surgical scars with the cryogen-cooled 595 nm pulsed dye laser starting on the day of suture removal.
Conologue TD, Norwood C.
Source Department of Dermatology, Walter Reed Army Medical Center, 6900 Georgia Avenue, Washington, DC 20007, USA. tconologue@msn.com

Abstract
BACKGROUND: Cosmetic results after skin surgery are a key component of patient satisfaction and self-image. Various lasers have been used to attempt scar improvement, without consistent results. The optimal time to initiate laser treatment has not been determined. A recent study using a noncooled 585 nm pulsed dye laser starting on the day of suture removal demonstrated substantial improvement in scar appearance. OBJECTIVE: To determine the efficacy of the 595 nm cryogen-cooled pulsed dye laser in the treatment of surgical scars starting on the day of suture removal. METHODS: Sixteen patients with postoperative linear scars of greater than 2 cm were treated three times at 4- to 8-week intervals with a 595 nm cryogen-cooled pulsed dye laser. All patients had Fitzpatrick skin types I to IV. Each scar was divided at the midline into two fields, with half receiving treatment using a 7 mm spot size at 1.5 ms with 8 J/cm2 and a 30 ms spray duration with a 10 ms delay. The other half was not treated. Scars were evaluated for pigmentation, vascularity, pliability, and height by a blinded examiner using the Vancouver Scar Scale (VSS). In addition, the same blinded examiner evaluated the cosmetic appearance using a scale from 0 (worst) to 10 (best) prior to the second treatment and 1 month after the final treatment. RESULT: SThe average sum of all parameters in the VSS showed significant improvement from 1-month post-treatment to the final evaluation of 60% compared with the control of -3%. Also, scars in the treated portions scored an average of 2 points higher in the overall cosmetic appearance by the same blinded examiner based on a scale of 0 (worst) to 10 (best). Among the individual parameters in the VSS, the most significant improvements were found in vascularity and pliability. CONCLUSION: The cryogen-cooled 595 nm pulsed dye laser is a safe and effective option to improve the cosmetic appearance of surgical scars in skin types I to IV starting on the day of suture removal. PMID:

16393593

[PubMed - indexed for MEDLINE]

Use of hemostatic gel in postpartum hemorrhage due to placenta previa.

Law LW, Chor CM, Leung TY.
Source Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. lwlaw@cuhk.edu.hk

Abstract

BACKGROUND: Hemostasis for placenta previa is notoriously difficult because of the poor contractility of the lower segment. A hemostatic gel offers a new type of hemostatic matrix, which may have advantages. CASE: A 35-year-old woman had a postpartum hemorrhage despite the use of uterotonics 2 hours after cesarean delivery for major placenta previa. On relaparotomy, heavy oozing from the placental site was found. Difficult accessibility and profuse bleeding prompted the consideration of alternative treatment with the topical application of hemostatic gel over the lower segment, which achieved hemostasis within minutes. CONCLUSION: Hemostatic gel is easily applicable and provides quick and effective hemostatic control in the lower segment, where surgical intervention may be difficult.

Placenta previa: distance to internal os and mode of delivery.

Vergani P, Ornaghi S, Pozzi I, Beretta P, Russo FM, Follesa I, Ghidini A.
Source Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy. pvergani@yahoo.it

Abstract
OBJECTIVE: The purpose of this study was to relate the mode of delivery and outcomes in a cohort of cases of placenta previa that had the last transvaginal ultrasonographic scan <28 days before delivery. STUDY DESIGN: Cases in which the placental edge overlapped the internal cervical (n = 42) underwent cesarean section delivery. Labor was allowed in those with placental edge to internal os distance of 1-10 mm (group 1, 24 women) and those with a distance of 11-20 mm (group 2, 29 women). RESULTS: Rates of cesarean section delivery (75% vs 31%; odds ratio, 6.7; 95% confidence interval [CI], 2-22) and of bleeding before labor (29% vs 3%; odds ratio, 11.5; 95% CI, 1.6-76.7) were higher in group 1 than in group 2. Blood loss at delivery (662 +/- 466 mL vs 510 +/- 547 mL) and rate of severe postpartum hemorrhage (21% vs 10%; odds ratio, 2.3; 95% CI, 0.5-9.7) were similar in the 2 groups. CONCLUSION: More than two-thirds of women with a placental edge to cervical os distance of >10 mm deliver vaginally without increased risk of hemorrhage. Comment in

y y

Am J Obstet Gynecol. 2009 Sep;201(3):227-9. Am J Obstet Gynecol. 2010 Jun;202(6):e10; author reply e10.

Cervical length and risk of antepartum bleeding in women with complete placenta previa.
Ghi T, Contro E, Martina T, Piva M, Morandi R, Orsini LF, Meriggiola MC, Pilu G, Morselli-Labate AM, De Aloysio D, Rizzo N, Pelusi G.

Source Department of Obstetrics and Gynecology, University Hospital of Bologna, Bologna, Italy. tullio.ghi@aosp.bo.it

Abstract
OBJECTIVE: To evaluate if cervical length predicts prepartum bleeding and emergency Cesarean section in cases of placenta previa. METHODS: Between September 2005 and September 2007, cervical length was measured by transvaginal ultrasound in women with complete placenta previa persisting into the third trimester of pregnancy. A complete follow-up of pregnancy was obtained in all cases. RESULTS: Overall, 59 women were included in the study group. The mean +/- SD gestational age at ultrasound was 30.7 +/- 2.7 weeks and the cervical length was 36.9 +/- 8.8 mm. Cesarean delivery was performed in all cases, at a mean gestational age of 34.7 +/- 2.3 weeks. Twenty-nine (49.1%) of the women presented prepartum bleeding and 12 (20.3%) required an emergency Cesarean section prior to 34 completed weeks due to massive hemorrhage. Cervical length did not differ significantly between cases with and those without prepartum bleeding (35.3 +/- 9.3 mm vs. 38.4 +/- 8.2 mm; P = 0.18), but was significantly shorter among patients who underwent emergency Cesarean section < 34 weeks due to massive hemorrhage compared with patients who underwent elective Cesarean section (29.4 +/- 5.7 mm vs. 38.8 +/- 8.5 mm; P = 0.0006). CONCLUSIONS: Transvaginal sonographic cervical length predicts the risk of emergency Cesarean section < 34 weeks in women with complete placenta previa.

Ultrasonographic cervical length and risk of hemorrhage in pregnancies with placenta previa.
Stafford IA, Dashe JS, Shivvers SA, Alexander JM, McIntire DD, Leveno KJ.
Source Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Abstract
OBJECTIVE: To estimate the relationship between cervical length and hemorrhage leading to preterm delivery in women with placenta previa. METHODS: Between October 2007 and May 2009, transvaginal cervical-length measurements were obtained in all singleton pregnancies with placenta previa identified at or beyond 24 weeks of gestation. Only women who delivered liveborn or stillborn neonates at our hospital and had placenta previa confirmed at delivery were included. Cervical length of 30 mm or less was considered short. Clinicians were blinded to cervical-length measurements. Chi-square and logistic regression were used for analysis. RESULTS: Of 89 identified women with placenta previa at initial ultrasonography, 68 had placenta previa at delivery, and 29 (43%) of these had a short cervix. Gestational age at cervical-length measurement was 32+/-4 weeks in women with

a short cervix and 33+/-2 weeks in those with a longer cervix (P=.4). Women with previa and a short cervix were more likely to require delivery for hemorrhage, 79% compared with 28%, and to deliver preterm, 69% compared with 21% (both P<.001). Tocodynamometer evidence of regular uterine contractions was more common with a short cervix than with a longer cervix, 69% compared with 21% (P<.001). Conversely, 64% with a cervical length greater than 30 mm had no bleeding episodes and progressed to term. CONCLUSION: In pregnancies with placenta previa, a third-trimester cervical length of 30 mm or less is associated with increased risk for hemorrhage, uterine activity, and preterm birth. LEVEL OF EVIDENCE: II. Comment in

Obstet Gynecol. 2010 Dec;116(6):1458; author reply 1458-9.