Tranexamic acid
Mechanism :
Tranexamic acid is a competitive inhibitor of plasminogen activation, and at much higher concentrations, a noncompetitive inhibitor of plasmin, i.e., actions similar to aminocaproic acid. Tranexamic acid is about 10 times more potent in vitro than aminocaproic acid.
Indication :
- Hereditary angioedema
- Menorrhagia
- Thrombolytic overdose
- Epistaxis palliation
- Mucus membrane bleeds
- Hyphema
Contraindications :
Contraindicated in patients with acquired defective color vision, in patients with subarachnoid hemorrhage, in patients with active intravascular clotting, in massive hematuria.
Dosing :
Oral
Menorrhagia:
1300 mg thrice daily, oral, for upto 5 days during menstruation.
Hereditary angioedema:
Short term prophylaxis:
75 mg/kg/day PO in 2-3 divided doses for 5 days before and after event.
Long term prophylaxis:
1000-1500 mg PO in 2-3 divided doses.
Treatment of acute attack:
25 mg/kg/dose IV/oral, max 1000 mg/dose every 3-4 hours.
Cone biopsy:
1000-1500 mg PO every 8-12 hours for 12 days postoperatively.
Epistaxis, Hyphema:
1000-1500 mg PO every 8-12 hours for 7-10 days.
Adverse Effect :
Nausea and vomiting, diarrhea, back pain, abdominal pain, nasal and sinus symptoms, headache, disturbances in color vision. Rapid IV injection may cause dizziness with or without the occurrence of hypotension.
Interaction :
Drug Interactions Not Available.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | IV: 10 mg/kg 12 hourly. Oral: 25 mg/ kg 12 hourly |
| 10-20 | IV: 10 mg/kg 12–24 hourly. Oral: 25 mg/kg 12–24 hourly |
| <10 | IV: 5 mg/kg 12–24 hourly. Oral: 12.5 mg/kg 12–24 hourly |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
No dose adjustment recommended.