Tranexamic acid
CYKLOKAPRON
Pronunciation: tran-ex-AM-ik AS-id
“Examine a Clog cap on”
What it isAntifibrinolytic blocking plasminogen binding to fibrin; hemorrhage and heavy menstrual bleeding.
Why this oneGiven within three hours it reduces mortality in trauma and postpartum hemorrhage, at negligible cost.
What limits itTiming is everything — after three hours it may increase mortality in trauma. Seizures at high dose; caution with thrombotic risk.
FDA-approved for
- cyclic heavy menstrual bleeding (2009)
- hemophilia dental extraction
Off-label
- trauma and postpartum hemorrhage
- melasma
- epistaxis
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hemophilia: reduce/prevent hemorrhage and need for replacement therapy during and after tooth extraction (short-term, 2–8 days) | Adults | 10 mg/kg (actual body weight) IV once immediately before extraction, with replacement therapy | 10 mg/kg IV TID–QID × 2–8 days after extraction | 10 mg/kg QID |
Renal Reduce all doses (before and after extraction) by SCr: 1.36–2.83 mg/dL: 10 mg/kg IV BID; 2.83–5.66: 10 mg/kg IV QD; >5.66: 10 mg/kg IV q48h or 5 mg/kg IV q24h.
Hepatic Undefined
Limited pediatric data suggest no significant PK differences from adults.
Instructions
- IV only—never neuraxial; confirm route and label syringes 'IV'.
- Undiluted (100 mg/mL): infuse ~0.5 mL/min, no faster than 1 mL/min (hypotension).
- Diluted to 10 or 20 mg/mL: infuse at 5 or 2.5 mL/min respectively; diluted solution stable up to 4 h at room temp.
- Do not mix with blood or penicillin-containing solutions; heparin may be added.
Available strengths
- inj 100 mg/mL
- tab 650 mg
Contraindications
- Neuraxial (intrathecal, epidural) injection
- Subarachnoid hemorrhage (cerebral edema and infarction)
- Active intravascular clotting
Cautions
- Medication errors from incorrect route
- Thromboembolic risk (avoid Factor IX complex, anti-inhibitor coagulant concentrates, hormonal contraceptives)
- Seizures
- Hypersensitivity reactions
- Visual disturbances
- Dizziness
Adverse reactions
- Nausea
- Vomiting
- Diarrhea
- Allergic dermatitis
- Giddiness
- Hypotension (rapid IV injection)
- Thromboembolic events
Pregnancy Crosses placenta (cord levels ≈ maternal); human data have not clarified risk; no adverse fetal effects in animal studies.
Lactation Present in human milk; no data on breastfed-infant effects or milk production; weigh benefits against maternal need.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 100 mg/mL | inj | per unit | $0.40/mL | not offered |
Generic entry2011
NO BOXED WARNINGS
No boxed warning for the oral tablet, but the intravenous injection carries a boxed warning for the risks of rapid intravenous administration.
Principal riskTiming: after three hours it may increase trauma mortality
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityThrombosis or serious bleeding from under- or overcorrection; agent-specific laboratory monitoring is often required.