General

Pronunciation
a-mee-noe-ka-PRO-ik

Trade Name(s)

• Amicar

• epsilon aminocaproic acid

Pregnancy Category
Category C

Ther. class.
hemostatic agents

Pharm. class.
fibrinolysis inhibitors

Indications

Management of acute, life-threatening hemorrhage due to systemic hyperfibrinolysis or urinary fibrinolysis

Unlabelled Use(s):

• Prevention of recurrent subarachnoid hemorrhage

• Prevention of bleeding following oral surgery in hemophiliacs

• Management of severe hemorrhage caused by thrombolytic agents

Action

Inhibits activation of plasminogen

Therapeutic Effect(s):

• Inhibition of fibrinolysis

• Stabilization of clot formation

Pharmacokinetics

Absorption: Rapidly absorbed following oral administration

Distribution: Widely distributed

Metabolism and Excretion: Mostly eliminated unchanged by the kidneys

Half-life: Unknown

TIME/ACTION PROFILE (peak blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2 hr	N/A
IV	unknown	2 hr	N/A

Contraindication/Precautions

Contraindicated in:
Active intravascular clotting

Use Cautiously in:

• Upper urinary tract bleeding

• Cardiac, renal, or liver disease (dosage reduction may be required)

• Disseminated intravascular coagulation (should be used concurrently with heparin)

• OB: Lactation: Safety not established

• Pedi: Do not use products containing benzyl alcohol with neonates

Adverse Reactions/Side Effects

CNS: dizziness, malaise.

EENT: nasal stuffiness, tinnitus.

CV: arrhythmias, hypotension (IV only).

GI: anorexia, bloating, cramping, diarrhea, nausea.

GU: diuresis, renal failure.

MS: myopathy.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• Concurrent use with estrogens, conjugated may result in a hypercoagulable state

• Concurrent use with clotting factors may risk of thromboses

Route/Dosage

Acute Bleeding Syndromes due to Elevated Fibrinolytic Activity

• PO (Adults): 5 g 1st hr, followed by 1–1.25 g q hr for 8 hr or until hemorrhage is controlled; or 6 g over 24 hr after prostate surgery (not > 30 g/day).

• IV (Adults): 4–5 g over 1st hr, followed by 1 g/hr for 8 hr or until hemorrhage is controlled; or 6 g over 24 hr after prostate surgery (not >30 g/day).

• PO, IV (Children): 100 mg/kg or 3 g/m² over 1st hr, followed by continuous infusion of 33.3 mg/kg/hr; or 1 g/m²/hr (total dosage not >18 g/m²/24 hr).

Subarachnoid Hemorrhage

• PO (Adults):
To follow IV—3 g q 2 hr (36 g/day). If no surgery is performed, continue for 21 days after bleeding stops, then decrease to 2 g q 2 hr (24 g/day) for 3 days, then 1 g q 2 hr (12 g/day) for 3 days.

• IV (Adults): 36 g/day for 10 days followed by PO.

Prevention of Bleeding Following Oral Surgery in Hemophiliacs

• PO (Adults): 75 mg/kg (up to 6 g) immediately after procedure, then q 6 hr for 7–10 days; syrup may also be used as an oral rinse of 1.25 g (5 ml) 4 times a day for 7–10 days.

• IV, PO (Children):
Also for epistaxis—50–100 mg/kg/dose administered IV every 6 hr for 2–3 days starting 4 hr before the procedure. After completion of IV therapy, aminocaproic acid should be given as 50–100 mg/kg/dose orally every 6 hr for 5–7 days.

Availability

• Tablets: 500 mg

• Syrup (raspberry flavor): 1.25 g/5 ml

• Injection: 250 mg/ml

Assessment

• Monitor blood pressure, pulse, and respiratory status as indicated by severity of bleeding

• Monitor for overt bleeding every 15–30 min

• Monitor neurologic status (pupils, level of consciousness, motor activity) in patients with subarachnoid hemorrhage

• Monitor intake and output ratios frequently; notify physician if significant discrepancies occur

• Assess for thromboembolic complications (especially in patients with history). Notify physician of positive Homans' sign, leg pain and edema, hemoptysis, dyspnea, or chest pain

Lab Test Considerations

• Monitor platelet count and clotting factors prior to and periodically throughout therapy in patients with systemic fibrinolysis

» CPK, AST, and serum aldolase may indicate myopathy

» May serum potassium

Potential Nursing Diagnoses

• Ineffective tissue perfusion (Indications)

• Risk for injury (Indications)(Side Effects)

Implementation

• Do not confuse Amicar (aminocaproic acid) with Amikin (amikacin)

• PO: Syrup may be used as an oral rinse, swished for 30 sec 4 times/day for 7–10 days for the control of bleeding during dental and oral surgery in hemophilic patients. Small amounts may be swallowed, except during 1st and 2nd trimesters of pregnancy. Syrup may be applied with an applicator in children or unconscious patients

IV Adminstration:

• IV:
Stabilize IV catheter to minimize thrombophlebitis. Monitor site closely

• Intermittent Infusion:
Diluent: Do not administer undiluted. Dilute initial 4–5 g dose in 250 ml of sterile water for injection, 0.9% NaCl, D5W, or LR. Do not dilute with sterile water in patients with subarachnoid hemorrhage.
Concentration: 20 mg/ml

• Rate:
Single doses: Administer over 1 hr. Rapid infusion rate may cause hypotension, bradycardia, or other arrhythmias

• Continuous Infusion:
Administer IV solution using infusion pump to ensure accurate dose. Administer via slow IV infusion

• Rate:
Initial dose may be followed by a continuous infusion of 1–1.25 g/hr in adults or 33.3 mg/kg/hr in children

• Additive Incompatibility:
Do not admix with other medications

Patient/Family Teaching

• Instruct patient to notify the nurse immediately if bleeding recurs or if thromboembolic symptoms develop

• IV: Caution patient to make position changes slowly to avoid orthostatic hypotension

Evaluation/Desired Outcomes

• Cessation of bleeding

• Prevention of rebleeding in subarachnoid hemorrhage without occurrence of undesired clotting

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