tranexamic acid injection (Rx)

Brand and Other Names:Cyklokapron
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100mg/mL

Dental Extraction in Patients with Hemophilia

Indicated in patients with hemophilia for short-term use (ie, 2-8 days) to reduce/prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction

10 mg/kg IV immediately before surgery OR 10 mg/kg IV q6-8hr 1 day before surgery  

25 mg/kg PO q6-8hr 1 day presurgery AND 2-8 days postsurgery

CABG (Off-label)

10-15 mg/kg IV over 20 minutes, THEN 1 mg/kg/hr continuous infusion for 6-10 hours  

Hereditary Angioedema (Off-label)

Long-term prophylaxis: 1000-1500 mg PO q8-12hr; reduce dose to 500 mg/dose PO qDay or q12hr when frequency of attacks reduces

Short term prophylaxis: 75 mg/kg/day PO divided q8-12hr for 5 days before and after the event  

Treatment of acute HAE attack: 25 mg/kg/dose PO/IV; not to exceed 1000 mg/dose q3-4hr; not to exceed 75 mg/kg/day or 1000 mg PO q6hr for 48 hr

Total Knee Replacement Surgery, Blood Loss Reduction (Off-label)

10 mg/kg IV over 30 min before inflation of tourniquet and 3 hr after first dose  

Hyphema (Off-label)

25 mg/kg PO q8hr for 5-7 days  

Renal Impairment

Dental Extraction

  • SCr 1.36-2.83 mg/dL (120-250 micromoles/L): 10 mg/kg IV q12hr OR 15 mg/kg PO q12hr
  • SCr 2.83-5.66 mg/dL (250-500 micromoles/L): 10 mg/kg IV qDay OR 15 mg/kg PO qDay
  • SCr >5.66 mg/dL (>500 micromoles/L): 10 mg/kg IV q48hr OR 15 mg/kg PO q48hr; alternatively, 5 mg/kg IV qDay OR 7.5 mg/kg PO qDay

Dosage Forms & Strengths

injectable solution

  • 100mg/mL

Dental Extraction in Patients with Hemophilia

10 mg/kg IV immediately before surgery OR 10 mg/kg IV q6-8hr 1 day before surgery

25 mg/kg PO q6-8hr 1 day presurgery AND 2-8 days postsurgery

Hyphema (Off-label)

25 mg/kg PO q8hr for 5-7 days

Hereditary Angioedema (Off-label)

Long term prophylaxis: 20-40 mg/kg/day PO divided q8-12hr; reduce dosing frequency to every other day or twice weekly when frequency of attacks reduces

Short term prophylaxis: 20-40 mg/kg/day PO divided q8-12hr; initiate 2-5 days before and continue for 2 days after the procedure

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Interactions

Interaction Checker

and tranexamic acid injection

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (1)

            • prothrombin complex concentrate, human

              tranexamic acid injection increases effects of prothrombin complex concentrate, human by pharmacodynamic synergism. Contraindicated. Coadministration increases risk of thrombosis.

            Serious - Use Alternative (3)

            • anti-inhibitor coagulant complex

              anti-inhibitor coagulant complex, tranexamic acid injection. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration ma.

              tranexamic acid injection, anti-inhibitor coagulant complex. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration ma.

            • Factor IX

              tranexamic acid injection increases effects of Factor IX by pharmacodynamic synergism. Contraindicated. Risk of thrombosis.

            • Factor IX, recombinant

              tranexamic acid injection increases effects of Factor IX, recombinant by pharmacodynamic synergism. Contraindicated. Risk of thrombosis.

            Monitor Closely (2)

            • defibrotide

              tranexamic acid injection decreases effects of defibrotide by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Defibrotide may diminish effects of thrombolytic agents. Consider therapy modification.

            • mestranol

              tranexamic acid injection, mestranol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of thromboembolic disorder.

            Minor (0)

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              Adverse Effects

              Frequency Not Defined

              Visual abnormalities

              Hypotension (with rapid injection)

              Nausea

              Vomiting

              Diarrhea

              Anaphylaxis

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              Warnings

              Contraindications

              Hypersensitivity

              Acquired defective color vision

              Subarachnoid hemorrhage

              Active intravascular clotting

              Cautions

              Use caution in renal impairment, subarachnoid hemorrhage, vascular disease, thromboembolic history, and DIC

              Ureteral obstruction resulting from clot formation reported; use caution in patients with upper urinary tract bleeding

              Thromboembolism or venous and arterial thrombosis reported

              Ligneous conjunctivitis has been reported

              Concurrent use with anti-inhibitor coagulant complex/factor IX complex concentrates may further increase risk of thrombosis

              Concurrent use with tretinoin may exacerbate procoagulant effects

              Anaphylaxis reported with intravenous administration

              For intravenous use only; serious adverse reactions including seizures and cardiac arrythmias have occurred when drug inadvertently administered intrathecally instead of intravenously; confirm correct route of administration and avoid confusion with other injectable solutions that might be administered at same time as the drug; syringes containing drug should be clearly labeled with intravenous route of administration

              Visual disturbances

              • Visual defects (color vision change or visual loss) reported
              • In addition, although not seen in humans, focal areas of retinal degeneration have been observed in cats and dogs following oral or intravenous tranexamic acid at doses between 250 to 1600 mg/kg/day (1.6 to 22 times recommended usual human dose based on body surface area) from 6 days to 1 year
              • No retinal changes observed in eye examinations of patients treated with tranexamic acid for up to 8 years; patients expected to be treated for greater than 3 months may consider ophthalmic monitoring including visual acuity and optical coherence tomography at regular intervals; discontinue tranexamic acid in sodium chloride injection if changes in ophthalmological examination occur

              Seizures

              • May cause seizures, including focal and generalized seizures; the most common setting for tranexamic acid-induced seizures has been during cardiovascular surgery (a setting in which drug is not FDA approved and which uses doses of up to ten-fold higher than recommended human dose and in patients inadvertently given tranexamic acid into the neuraxial system)
              • Consider dose reduction during surgery and dose adjustments for patients with clinical conditions such as renal dysfunction; closely monitor patient during surgery
              • Consider electroencephalogram (EEG) monitoring for patients with history of seizures or who experience myoclonic movements, twitching, or show evidence of focal seizures; discontinue drug if seizures occur
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              Pregnancy & Lactation

              Pregnancy

              Available data from published studies, case series and case reports with tranexamic acid use in pregnant women in second and third trimester and at time of delivery have not clarified whether there is a drug-associated risk of miscarriage or adverse maternal or fetal outcomes

              There are 2 (0.02%) infant cases with structural abnormalities that resulted in death when tranexamic acid was used during conception or first trimester of pregnancy; however, due to other confounding factors the risk of major birth defects with use of tranexamic acid during pregnancy is not clear

              Drug is known to pass the placenta and appears in cord blood at concentrations approximately equal to maternal concentration

              Animal data

              • Reproduction studies performed in mice, rats, and rabbits have not revealed any adverse effects on fetus due to tranexamic acid administered during organogenesis; doses examined were multiples of up to 3 times (mouse), 6 times (rat), and 3 times (rabbit) maximum human dose based on body surface area in the mouse, rat, and rabbit, respectively

              Contraception

              • Concomitant use of drug, which is an antifibrinolytic, with hormonal contraceptives may increase risk for thromboembolic adverse reactions; advise patients to use an effective alternative (nonhormonal) contraceptive method

              Lactation

              Published literature reports presence of tranexamic acid in human milk; there are no data on effects of drug on breastfed child or effects on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Inhibits fibrinolysis by displacing plasminogen from fibrin

              Reduces plasmin activity, which in turn reduces activation of complement and consumption of C1 esterase inhibitor (C1-NH) and subsequently decreases inflammation associated with hereditary angioedema

              Pharmacokinetics

              Half-Life: 2-11 hr

              Duration: 3 hr (after 1 dose)

              Peak Plasma time: 3 hr

              Plasma concentration: 15 mg/L

              Protein Bound: 3%

              Vd: 9-27 L

              Clearance: 110-116 mL/min

              Excretion: Urine (95%)

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              Administration

              IV Incompatibilities

              Additive: blood, penicillin

              IV Compatibilities

              Solution: compatible with most common solutions for infusion

              Additive: heparin

              IV Preparation

              Prepare solution same day it will be used

              Dilute a single dose w/t 50 mL compatible fluid (eg, NS, Ringers, dextrose/water)

              IV Administration

              100 mg or fraction thereof over at least 1 min, usually 5 minutes

              Avoid rapid infusion

              Storage

              Store at 25°C (77°F)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Lysteda oral
              -
              650 mg tablet
              tranexamic acid oral
              -
              650 mg tablet
              tranexamic acid oral
              -
              650 mg tablet
              tranexamic acid oral
              -
              650 mg tablet
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) solution
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              tranexamic acid intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              Cyklokapron intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              Cyklokapron intravenous
              -
              1,000 mg/10 mL (100 mg/mL) solution
              Cyklokapron intravenous
              -
              1,000 mg/10 mL (100 mg/mL) vial
              Cyklokapron intravenous
              -
              1,000 mg/10 mL (100 mg/mL) solution

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

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              Patient Education
              tranexamic acid oral

              TRANEXAMIC ACID 650 MILLIGRAM TABLET - ORAL

              (TRAN-ex-AM-ik AS-id)

              COMMON BRAND NAME(S): Lysteda

              USES: This medication is used to treat heavy bleeding during your menstrual period. Tranexamic acid works by slowing the breakdown of blood clots, which helps to prevent prolonged bleeding. It belongs to a class of drugs known as antifibrinolytics.Tranexamic acid is not a hormone. It does not treat other menstrual or pre-menstrual symptoms. It does not stop your period. It is not a form of birth control and does not protect against sexually transmitted diseases.

              HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking tranexamic acid and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually 2 tablets 3 times a day (morning, afternoon, bedtime). Swallow this medication whole. Do not crush or chew. Wait until your period has started before taking your first dose. Do not take tranexamic acid for more than 5 days in a row.Dosage is based on your medical condition and response to treatment. Do not take more than 3 doses (6 tablets) in 24 hours. Stop taking tranexamic acid and see your doctor right away if you have any eye problems or change in vision.Tell your doctor if there is a change in your bleeding pattern or heavy bleeding lasts or gets worse.

              SIDE EFFECTS: See also How to use section.Nausea, vomiting, diarrhea, and muscle pain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: eye/eyelid problems.Although unlikely, this medication may cause serious blood clot problems. Stop taking tranexamic acid and get medical help right away if any of these very serious side effects occur: coughing up blood, fainting, chest/jaw/left arm pain, pain/swelling/warmth in the groin/calf, swelling/weakness/redness/pain in the arms/legs, signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion), vision changes (such as color vision changes, decreased vision/blindness).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking tranexamic acid, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding in the brain (subarachnoid hemorrhage), history of blood clots (such as in the legs, lung, brain, eye), certain heart diseases (irregular heartbeat, heart valve problems), blood clotting problems, kidney problems (including blood in the urine), irregular menstrual bleeding of unknown cause.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication is usually used during your menstrual period. It is unlikely to be used during pregnancy. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: "blood thinners" (anticoagulants such as warfarin, heparin), drugs that prevent bleeding (including factor IX complex, anti-inhibitor coagulant concentrates), estrogens, hormonal birth control (such as pills, patch, ring), tibolone, tretinoin.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as aspirin, ibuprofen, naproxen) that may increase your risk of bleeding. Low-dose aspirin should be continued if prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually 81-162 milligrams a day). Ask your doctor or pharmacist for more details.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, vomiting.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as kidney tests, eye examinations) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised February 2022. Copyright(c) 2022 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
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              NC NOT COVERED – Drugs that are not covered by the plan.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.