Tranexamic acid
CYKLOKAPRON
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 |
|---|---|---|---|---|
| Cyclic heavy menstrual bleeding | Adults (normal renal function) | 1300 mg TID | 1300 mg TID | 3900 mg/day, max 5 days/menstrual cycle |
Renal Reduce dose by serum creatinine: Cr >1.4–2.8 mg/dL: 1300 mg BID; >2.8–5.7: 1300 mg QD; >5.7: 650 mg QD
Hepatic No adjustment needed
Use limited to a maximum of 5 days during each menstrual period
Instructions
- Take with or without food
- Swallow tablets whole; do not chew or break apart
- Use for a maximum of 5 days during monthly menstruation
Contraindications
- Concomitant use of combined hormonal contraceptives
- Active thromboembolic disease, or history or intrinsic risk of thrombosis/thromboembolism (including retinal vein or artery occlusion)
Cautions
- Venous/arterial thromboembolism including retinal artery/vein occlusion
- Discontinue immediately for visual or ocular symptoms
- Increased thrombosis risk with hormonal contraceptives, Factor IX/anti-inhibitor coagulant concentrates, or all-trans retinoic acid (oral tretinoin)
- Severe allergic reactions/anaphylaxis
- Cerebral edema and infarction in subarachnoid hemorrhage
- Ligneous conjunctivitis
Adverse reactions
- Headache
- Nasal/sinus symptoms
- Back pain
- Abdominal pain
- Musculoskeletal pain
- Arthralgia
- Muscle cramps/spasms
- Migraine
- Anemia
- Fatigue
Pregnancy Not indicated in pregnancy; no human data; crosses placenta; animal studies show no adverse developmental effects
Lactation Present in milk at ~1% of peak serum concentration; effects on breastfed infant unknown
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
Cost, est. cash$500–$20,000+/dose or month
Generic entry2011
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.
Mechanism of action: Tranexamic acid ballicule
Open Tranexamic acid in the interactive console ↗
Memory aids: mascots and interaction avatars
