Tranexamic Acid (Oral)

Tranexamic Acid does not treat underlying causes of heavy periods like infections and uterine cancer, hence there is a need to consult your gynecologist for accurate diagnosis and treatment of heavy menstrual periods.

Overview

Discovered by Utako Okamoto in 1962, tranexamic acid is a synthetic form of amino acid called lysine. It belongs to the class of medications called antifibrinolytic agents. Tranexamic acid is used to reduce or prevent excessive bleeding in certain conditions such as heavy menstrual bleeding, bleeding inside the eye and nose bleeds. It is also used to treat or prevent excessive bleeding during cervical surgery and dental surgery in patients with hereditary blood clotting disorders.

Tranexamic acid works by preventing the enzymes from breaking down blood clots. In certain medical conditions, the body breaks down blood clots too fast, preventing bleeding from stopping and the wound from healing. Tranexamic acid is available under multiple brand names and in several forms. The most common brand name prescribed for women with menstrual bleeding is Lysteda.

Tranexamic acid is not for everyone. Do not take this medication if you:

  • Have a history or are at a greater risk of forming blood clots
  • Are allergic to tranexamic acid or the ingredients used in the medication
  • Suffer from active blood clotting conditions such as pulmonary embolism, deep vein thrombosis and cerebral thrombosis
  • Have blood in stool and urine
  • Have bleeding in the linings of the brain
  • Have difficulty in distinguishing colors

Conditions treated by tranexamic acid

  • Heavy bleeding during monthly periods
  • Hereditary angioedema
  • Excessive blood loss from trauma
  • Post-partum bleeding
  • Nose bleeds
  • Tooth removal

Type of medicine

  • Synthetic protein

Drug class

  • Antifibrinolytic agent

Tranexamic acid side effects

Along with the desired effects, tranexamic acid may also cause some undesirable effects on the patients. Although not all of these side effects may be exhibited by the patient, there may be need for medical attention depending on their severity.

Most common tranexamic side effects:

Gastrointestinal

Some of the gastrointestinal side effects associated with tranexamic acid include vomiting, nausea and diarrhea. Some patients have also reported abdominal pain after using this medication.

Nervous system

Nervous system side effects of tranexamic acid include dizziness, tension headache, giddiness and migraine.

Hematologic

Hematologic side effects of tranexamic acid include anemia and thromboembolic events such as pulmonary embolism, deep vein thrombosis, acute renal cortical necrosis, cerebral thrombosis, and central retinal and vein obstruction.

Hypersensitivity

Hypersensitivity side effects of tranexamic acid include anaphylactic shock, allergic skin reactions and anaphylactoid reactions. Rare hypersensitivity reactions include tightening of the throat, dyspnea and facial flushing. These reactions may require emergency treatment.

Ocular

Ocular side effects are rare. However, the temporary disturbance of color vision and retinal artery occlusion could occur.

Musculoskeletal

Some of the common musculoskeletal side effects of tranexamic acid include back pain, muscle cramps, musculoskeletal pain, spasms, arthralgia including joint swelling and stiffness and myalgia.

Respiratory

Respiratory side effects of this drug include nasal and sinus symptoms such as sinusitis, respiratory tract and sinus congestion, sinus headache, acute sinusitis, sinus pain and allergic sinusitis.

Cardiovascular

Cardiovascular side effects of tranexamic acid include hypotension in cases where intravenous administration is greater than 1 mL per minute.

Genitourinary

Ureteral obstruction due to clot formation in patients with upper urinary tract bleeding have been linked to use of tranexamic acid.

Some of the tranexamic acid's side effects do not require medical attention as they are likely to go away as the body adjusts to treatment. Also, your doctor may be able to tell you how to prevent or manage some of these side effects. Check with your healthcare provider if any of the following side effects persist and are bothersome:

  • Chills or fever
  • Abdominal or stomach discomfort and/or tenderness
  • Difficulty with moving
  • Stuffy or running nose
  • Muscle aches and cramps
  • Headache and severe throbbing
  • Joint or back pain

Tranexamic acid dosage

Adult dosage for bleeding

For treatment of heavy menstrual bleeding:

  • 1300 mg (or two 650 mg tablets) should be taken orally three times a day for up to 5 days during the monthly menstruation.

For treating teenagers (ages 12 to 18 years old) with heavy menstrual bleeding:

  • 1300 mg (or 2 650 mg tablets) should be taken orally three times a day for up to 5 days during the menstruation period.

For short term use by patients suffering from hemophilia during dental extraction:

  • Immediately before tooth extraction, the patient should receive 10 mg per kg of body weight. The drug should be administered intravenously. This should be followed by an intravenous dose of 10 mg per kg of body weight three to four times per day for 2 to 8 days.

Pediatric dose for bleeding

Tranexamic acid has, on limited occasions, be used in pediatric treatments. This use has been limited to tooth extraction. For short-term use in patients with hemophilia, 10 mg per kg body weight should be administered intravenously three to four times a day for 2 to 8 days.

The FDA has not approved the drug for use in the following conditions hence limited data is available on direction of use:

  • Surgery for congenital heart disease
  • Surgery for scoliosis

Renal dose adjustments

Oral:

Serum creatinine above 1.4 mg/dL and less than or equal to 2.8 mg/dL.

  • 1300 mg (or two 650 mg tablets) should be taken orally two times a day for up to 5 days during the menstruation period.

Serum creatinine above 2.8 mg/dL and less than or equal to 5.7 mg/dL.

  • 1300 mg (or two 650 mg tablets) should be taken orally one a day for up to 5 days during the menstruation period.

How to use tranexamic acid

Tranexamic acid comes as tablets that are taken orally. The drug can be taken with or without food. Begin the medication each month at the onset of your period. Do not take the medication when you do not have a period. Take the medication around the same time every day. Do not take more than six tablets of tranexamic acid in a period of 24 hours. Also, do not take the medication for more than five days in a menstrual cycle.

The tablet should be swallowed whole. Do not chew, split or grind them. Do not share your medication with others.

Tranexamic acid overdose

Contact the poison control center or the emergency room immediately in an event of an overdose. Call the local poison control center on 1-800-222-1222. Symptoms of overdose may include dizziness and vomiting.

Missed dose

If you miss your dose, take the drug as soon as you remember. If it is a few hours to the next dose, skip the missed dose and resume your usual dosing schedule. Do not double dose.

Tranexamic acid interactions

Avoid all forms of hormonal birth controls such as pills, implants, injections, vaginal rings and skin patches when using this medication. Hormonal contraceptives may increase your risk of blood clot, heart attack or stroke while using tranexamic acid. If you have to use birth control while on this medication, consider barrier forms like condoms.

Other drugs that may interact with tranexamic acid include:

  • Chemotherapy medications for leukemia
  • Tretinoin
  • Fibrinogen
  • Any type of medication used for treating blood clots and bleeding episodes

Warnings and precautions

Like with any medication, inform your doctor of any medical conditions and allergies you may have before using tranexamic acid. Also, be sure to indicate whether you are breastfeeding as this may affect how you should use this medication.

Birth control

As already mentioned, hormone-based birth controls, when used alongside tranexamic acid, may increase your risk of stroke, heart attack and blood clots. Therefore, if you are using any form of hormonal birth control, be sure to discuss with your doctor how this medication may affect your health.

Blood clots

Tranexamic acid promotes blood clot formation. As such, it may cause reduction of blood flow to organs or extremities. Individuals with a history of blood clotting are at a greater risk of developing blood clot related problems like stroke, heart attacks and clots in the deep veins, which may increase as a result of this medication. Discuss with your healthcare provider how this medication may affect your overall medical condition, and how your condition may affect the dosing and eventual effectiveness of this medication, and whether you may need any special monitoring.

Call your doctor or the emergency room immediately when you experience symptoms such as swelling of limbs, blurred vision, breathing difficulty, sharp chest pains and speaking difficulty.

Drowsiness and impaired alertness

This medication may cause sluggishness and impaired alertness, hindering your ability to operate machinery or drive. It is advisable that you avoid tasks that require attention and focus until you have determined how your system responds to this medication.

Impaired vision

Regular use of tranexamic acid may cause impairment to your vision. This can be in the form of change in color recognition, blurred vision and apparent change in field of vision. If you notice any changes to your vision while on this medication, contact your healthcare provider as soon as possible. Your doctor may recommend an eye examination before starting this medication so changes in your vision can be identified.

Pregnancy

Tranexamic acid should never be used during pregnancy unless the benefits far outweigh the risks. Contact your doctor immediately if you conceive while taking this medication.

Breastfeeding

Tranexamic acid can pass into breast milk, albeit in small amounts. Therefore, taking this medication while breastfeeding may affect your baby. Talk to your healthcare provider about the risks involved in breastfeeding while on this medication.

Children

The safety and effectiveness of using tranexamic acid for treating heavy menstrual flow in adolescent girls is yet to be established. Talk to your doctor before giving this medication to your child.

Seek emergency help if you exhibit signs of allergic reactions to tranexamic acid. Some of these signs may include breathing difficulty, hives, swelling on the lips, face, tongue and throat.

Stop using tranexamic acid completely when you experience:

  • Vision problems (including impairment of color vision)
  • Light-headed feeling and passing out
  • Seizures and convulsions
  • Signs of stroke like sudden weakness and numbness especially on one side of your body, slurred speech, sudden and severe headache, and problems with balance and vision
  • Painful or difficult urination with blood in urine
  • Signs of blood clot in your lungs such as sudden cough, chest pain, wheezing, coughing of blood and rapid breathing, or
  • Signs of blood clot in your limbs such as swelling, pain, warm and redness on the limbs

Tranexamic acid storage

Tranexamic acid should be stored at room temperature between 15 – 30 degree C (59- 86 degrees F). Keep the drug away from moisture and sunlight. Do not store tranexamic acid in the bathroom. Keep the medicine away from pets and children. Do not discard of the medication down the toilet, the drain or trash bin. Consult the local pharmacy or waste disposal company for details on safe disposure of expired or unneeded medication. Finally, keep the medication in the original container it came in.

Summary

Tranexamic acid is a synthetic amino acid (protein) that is used for treating a range of hemorrhagic conditions. The medication works by reducing post-operative blood losses and transfusion requirements in different types of surgical procedures with potentially high tolerability and cost advantages over aprotinin. It is also known to reduce mortality rates and urgent surgery in patients with upper gastrointestinal hemorrhage.

Tranexamic acid is also used to reduce heavy menstrual blood loss in women. It is also used as an alternative to surgery in menorrhagia. Some doctors have also used this medication to control bleeding during pregnancy. However, tranexamic acid should only be used in pregnancy when the benefits outweigh the risks involved.

Belonging to the class of drugs known as antifibrinolytics, tranexamic acid treats heavy bleeding during menstruation by slowing the breakdown of blood clots, which in return helps prevent extensive bleeding. However, it is important to note that tranexamic acid is not a hormone. As such, it cannot be used as a treatment for other menstrual or premenstrual symptoms. It does not stop menstruation. Tranexamic acid is not a birth control either, and it cannot protect against sexually transmitted infections.

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Last Reviewed:
December 23, 2017
Last Updated:
April 03, 2018
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