tranexamic acid

General

Pronunciation
tran-ex-AM-ikAS -id

Trade Name(s)

• Cyklokapron

• Lysteda

Pregnancy Category
Category B

Ther. class.
hemostatic agents

Pharm. class.
antifibrinolytics
plasminogen inactivators

Indications

• IV: Prevention or reduction of hemorrhage during and following dental surgery in hemophiliacs.

• PO: Treatment of cyclic heavy menstrual bleeding.

Action

Inhibits activation of plasminogen, thereby preventing the conversion of plasminogen to plasmin.

Therapeutic Effect(s):

• Decreased bleeding following dental surgery in hemophiliacs.

• Reduced need for replacement therapy.

• Reduced menstrual blood loss.

Pharmacokinetics

Absorption: 100% bioavailable with IV administration; 45% bioavailability after oral administration.

Distribution: Penetrates readily into joint fluid and synovial membranes.

Metabolism and Excretion: 95% excreted unchanged in urine.

Half-life: 2 hr (IV) (↑ in renal impairment); 11 hr (PO).

TIME/ACTION PROFILE (blood levels)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	unknown	7–8 hr
PO	unknown	2.5 hr	unknown

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;

• Thromboembolic disorders (current, history of, or at risk for);

• Acquired defective color vision (IV);

• Subarachnoid hemorrhage.

Use Cautiously in:

• Renal impairment (↑ dosing interval);

• Hematuria originating in the upper urinary tract;

• Conditions associated with ↑ thrombus formation;

• Use of hormonal contraceptives (PO);

• OB: Lactation: Pedi: Safety not established.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache, dizziness.

EENT: visual abnormalities.

CV: hypotension, thromboembolism, thrombosis.

GI: diarrhea, nausea, vomiting.

MS: pain.

Misc: PO—ANAPHYLAXIS .

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

Interactions

Drug-Drug

• Concurrent use of clotting factor complexes may ↑ the risk of thrombotic complications (give tranexamic acid 8 hr following clotting factor replacement therapy).

• Concurrent use of hormonal contraceptives may ↑ risk of thrombosis (PO).

• May ↑ the procoagulant effects of all-trans retinoic acid .

• ↓ effectiveness with thrombolytic agents .

Route/Dosage

• IV (Adults and Children): 10 mg/kg just prior to surgery with appropriate replacement therapy, then 10 mg/kg 3–4 times daily for 2–8 days..

Renal Impairment

• IV (Adults and Children): SCr 1.36–2.83 mg/dL—10 mg/kg twice daily; SCr 2.83–5.66 mg/dL— 10 mg/kg daily; SCr >5.66 mg/dL— 10 mg/kg every 48 hr or 5 mg/kg once daily..

• PO (Adults): 1300 mg 3 times daily for a maximum of 5 days during menstruation..

Renal Impairment

• PO (Adults): SCr 1.41–2.8 mg/dL–1300 mg twice daily for a maximum of 5 days during menstruation; SCr 2.81–5.7 mg/dL–1300 mg daily for a maximum of 5 days during menstruation; SCr >5.7 mg/dL–650 mg daily for a maximum of 5 days during menstruation;..

Availability

• Solution for injection: 100 mg/mL

• Tablets: 650 mg

Assessment

Prevention of post-surgical hemorrhage

• Observe site of surgery for excessive bleeding.

Heavy menstrual bleeding

• Monitor menstrual flow prior to and during therapy.

• Patients taking tranexamic acid for more than several days should have ophthalmologic examinations to detect visual abnormalities prior to and at regular intervals during and after therapy. Discontinue therapy if visual changes occur.

Potential Nursing Diagnoses

• Risk for injury (Indications)

• Deficient knowledge , related to medication regimen (Patient/Family Teaching)

Implementation

PO: Administer 3 times daily without regard to food. Swallow tablets whole; do not crush, break, or chew.

IV Adminstration:

• Intermittent Infusion:

Diluent: May be diluted with most solutions, such as electrolyte, carbohydrate, amino acid, and dextran solutions. Prepare mixture on day of infusion.

• Rate:
Infuse at a rate not to exceed 100 mg (1 mL)/min. More rapid administration has resulted in hypotension.

• Y-Site Compatibility:

» heparin

• Y-Site Incompatibility:

» ampicillin

» ampicillin/sulbactam

» blood

» penicillin

» piperacillin/tazobactam

» ticarcillin/clavulanate

Patient/Family Teaching

• Instruct patient to take medication as directed; do not take more than 6 tablets/day, for longer that 5 days in any menstrual cycle, or when not menstruating. Take missed doses as soon as remembered, then take next dose as least 6 hrs later; do not double doses. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.

• Advise patient to stop medication and inform health care professional of any changes in vision. Inform patients on prolonged therapy of the importance of regular ophthalmologic follow-up.

• Caution patient to avoid products containing aspirin or NSAIDs without consulting health care professional.

• Instruct patient to notify health care professional if signs and symptoms of thrombosis (severe, sudden headache; pains in chest, groin, or legs, especially calves; sudden loss of coordination; sudden and unexplained shortness of breath; slurred speech; visual changes; weakness or numbness in arm or leg) or anaphylaxis (shortness of breath, throat tightness, rash) occur.

• Instruct patient to notify health care professional if heavy menstrual bleeding persists or worsens or if bleeding does not lessen after 2 cycles or tranexamic acid seems to stop working.

Evaluation/Desired Outcomes

• Prevention of hemorrhage during and following dental surgery in hemophiliacs.

• Reduced menstrual blood loss.