Tranexamic Acid
Generic Name: Tranexamic Acid
Brand Names: Lysteda, Cyklokapron
Tranexamic acid is an antifibrinolytic that reduces bleeding in heavy menstrual periods, surgery, and trauma.
Drug Class
Antifibrinolytic Agent
Pregnancy
Not formally categorized; use only if clearly needed (risk evaluation required per current FDA labeling)
Available Forms
650 mg oral tablet, 100 mg/mL injection solution
What It's Used For
Dosage Quick Reference
These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Typical Maintenance Dose |
|---|---|---|
| Heavy menstrual bleeding | 1,300 mg (two 650 mg tablets) three times daily | 1,300 mg three times daily for up to 5 days per cycle |
| Short-term prevention of bleeding in hemophilia (oral) | 25 mg/kg three times daily | 25 mg/kg two to three times daily for 2–8 days |
| Surgical bleeding prevention (IV) | 10 mg/kg IV before surgery | 10 mg/kg IV every 6–8 hours post-op |
Side Effects
Common Side Effects:
- Headache
- Nasal/sinus symptoms
- Back pain
- Abdominal pain
- Musculoskeletal pain
- Fatigue
Serious Side Effects:
- Thromboembolic events (DVT, PE, stroke)
- Visual disturbances (including color vision changes)
- Seizures (especially with high doses or renal impairment)
- Hypersensitivity reactions
Drug Interactions
Major Drug & Food Interactions
- Hormonal contraceptives (estrogen-containing): Concurrent use increases the risk of thromboembolic events (blood clots); generally avoid combining.
- Factor IX complex concentrates / Anti-inhibitor coagulant concentrates: Co-administration may increase thrombotic risk; avoid concomitant use.
- Tissue plasminogen activators (tPA, alteplase, tenecteplase): Tranexamic acid directly antagonizes fibrinolytic agents, reducing their efficacy.
- Tretinoin (all-trans retinoic acid): Both agents can affect coagulation; monitor closely for thromboembolic complications.
- Other prothrombotic agents (e.g., aminocaproic acid): Additive antifibrinolytic effects increase clot risk; do not combine.
Additional Information
Tranexamic acid is an antifibrinolytic medication that inhibits the breakdown of blood clots. It is used to reduce or prevent bleeding in various clinical situations, including heavy menstrual bleeding, surgery, trauma, and hereditary angioedema.
Mechanism of Action
Tranexamic acid prevents clot breakdown:
- Plasminogen binding inhibition: Binds to lysine-binding sites on plasminogen
- Prevents plasmin formation: Blocks conversion of plasminogen to plasmin
- Stabilizes fibrin clots: Plasmin normally degrades fibrin; blocking this preserves clots
- Antifibrinolytic effect: Net result is reduced bleeding
Unlike aminocaproic acid, tranexamic acid is about 10 times more potent.
Available Formulations
- Tablets: 650 mg (Lysteda)
- Injectable solution: 100 mg/mL
- Oral solution: Various compounded preparations
Medical Uses
FDA-Approved Indications:
- Heavy menstrual bleeding
- Short-term prevention of bleeding in hemophilia patients during dental procedures
- Reduction of perioperative blood loss in cardiac surgery
Off-Label Uses:
- Trauma-associated hemorrhage
- Postpartum hemorrhage
- Epistaxis
- Hereditary angioedema prophylaxis
- Melasma (topical)
Dosing Guidelines
Heavy Menstrual Bleeding:
- 1300 mg (two 650 mg tablets) three times daily for up to 5 days during menstruation
- Maximum: 3900 mg/day
Dental Procedures (Hemophilia):
- 25 mg/kg orally 2-3 times daily starting one day before procedure
- Continue 2-8 days post-procedure
Trauma (IV):
- 1 g IV over 10 minutes, then 1 g IV over 8 hours
Renal Impairment:
- Serum creatinine 1.4-2.8: 1300 mg twice daily
- Serum creatinine 2.9-5.7: 1300 mg once daily
- Serum creatinine >5.7: 650 mg once daily
Important Safety Information
Contraindications:
- Active thromboembolic disease (DVT, PE, cerebral thrombosis)
- History of thrombosis or thromboembolism
- Intrinsic risk of thrombosis (certain thrombophilias)
- Subarachnoid hemorrhage (risk of cerebral edema and infarction)
- Hypersensitivity to tranexamic acid
Warnings and Precautions:
- Thromboembolic events: May increase risk; assess individual risk factors
- Visual disturbances: Discontinue and obtain ophthalmologic evaluation
- Seizures: Risk with high doses or renal impairment
- Concurrent use with hormonal contraceptives: May further increase thrombotic risk
Drug Interactions
- Hormonal contraceptives: Increased thrombotic risk
- Factor IX complex concentrates, anti-inhibitor coagulant concentrates: Increased thrombotic risk
- Tissue plasminogen activators (tPA, alteplase): Antagonizes thrombolytic effects
- Tretinoin (all-trans retinoic acid): May cause fatal thrombosis in promyelocytic leukemia patients
Special Populations
- Hepatic Impairment: No specific adjustment
- Renal Impairment: Reduce dose based on serum creatinine
- Pregnancy: Limited data; use only if clearly needed
- Lactation: Present in milk at low concentrations
- Pediatric: Safety established for dental procedures in hemophilia
Frequently Asked Questions
Questions to Ask Your Doctor
Consider discussing these topics at your next appointment:
- ✓Should I avoid tranexamic acid if I have a history of blood clots or clotting disorders?
- ✓Is it safe for me to take tranexamic acid alongside my current birth control method?
- ✓How will my kidney function affect the dose of tranexamic acid I need?
- ✓Are there any vision-related side effects I should watch for during treatment?
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.
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Questions About This Medication?
Talk to your doctor or pharmacist about whether Tranexamic Acid is right for you.
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