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# Tranexamic acid ## Overview Tranexamic acid is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, a key enzyme responsible for fibrinolysis. This action helps to stabilize blood clots. ## Primary Indications * Management of heavy menstrual bleeding. * Treatment and prevention of bleeding in patients with hyperfibrinolysis (e.g., certain surgical procedures, trauma). * Management of epistaxis. * Hereditary angioedema (prophylaxis and treatment of acute attacks). ## Adult Dosing * **Heavy Menstrual Bleeding:** 1300 mg (typically 2 capsules) orally three times daily, not to exceed 3900 mg per day, for up to 5 days during menstruation. * **Dental Procedures (low risk):** 50 mg/kg orally every 8 hours for up to 4 days, starting before the procedure. Maximum dose not established for this indication. * **Trauma/Hemorrhage (specific protocols):** Dosing varies significantly based on protocol and patient weight. Common regimens include: * Loading dose: 1 gram IV over 10 minutes, followed by 1 gram IV infusion over 1 hour. * Alternative: 15 mg/kg IV bolus, then 2 mg/kg/hr infusion. * Protocols should be followed precisely. * **Hereditary Angioedema:** * **Prophylaxis:** 1000 mg orally two to three times daily. * **Acute Attacks:** 1000 mg orally three times daily until symptoms resolve. ## Pediatric Dosing Dosing for pediatric patients is not well-established in all indications. Consult specific pediatric guidelines or extrapolate from adult data with caution. * **Heavy Menstrual Bleeding:** Dosing is extrapolated from adult data, typically 15-25 mg/kg/dose orally 3 times daily. Maximum dose not to exceed adult maximum. ## Dose Adjustments * **Renal Impairment:** Dose reduction is necessary. * CrCl 50-80 mL/min: Reduce dose by 50%. * CrCl 10-50 mL/min: Reduce dose by 75%. * CrCl <10 mL/min: Reduce dose by 90%. * Use the lowest effective dose. ## Contraindications * Active thromboembolic disease (e.g., DVT, PE, arterial thrombosis). * Acquired defects in color vision. * Hypersensitivity to tranexamic acid. * Subarachnoid hemorrhage (may increase risk of vasospasm and infarction). ## Adverse Effects * **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache. * **Serious:** Thrombosis (including DVT, PE, MI, CVA), hypersensitivity reactions, visual disturbances, dizziness. ## Key Drug Interactions * **Hormonal contraceptives:** Increased risk of thrombosis. * **Factor VIIa (recombinant):** Increased risk of thrombosis. * **Antifibrinolytics (e.g., aminocaproic acid):** Concurrent use is generally not recommended due to increased risk of thrombotic events. ## Monitoring * Monitor for signs and symptoms of thromboembolic events (e.g., leg pain/swelling, chest pain, shortness of breath, sudden weakness/numbness, visual changes). * Monitor for signs of allergic reaction. * If used for excessive bleeding, monitor hemoglobin and hematocrit. * If used for hereditary angioedema, monitor for acute symptom resolution. ## Clinical Pearls * Tranexamic acid is most effective when initiated early in spontaneous or post-operative bleeding. * Oral formulation is suitable for many indications, including heavy menstrual bleeding and pre-procedural prophylaxis. * IV administration is typically reserved for acute, life-threatening bleeding or when oral administration is not feasible. * Always consider renal function for dose adjustments. **Disclaimer:** This information is intended for clinical decision support and does not replace professional medical judgment or current prescribing information. Always verify with the most up-to-date drug facts and product labeling.