tranexamic acid: clinical use

Prescribing considerations

• Confirm the cause and pattern of bleeding; irregular menstrual bleeding requires assessment rather than pharmacy self-treatment.
• Assess renal function because tranexamic acid is predominantly eliminated unchanged in urine and accumulates in renal impairment.
• Review thromboembolic history, hormonal contraception, seizure history and visual symptoms.
• Use particular caution with upper urinary-tract haematuria because retained clots may obstruct urinary flow.
• For injection, prevent wrong-route errors and verify intravenous administration.

Contraindications and cautions

• Selected injection: hypersensitivity, acute venous or arterial thrombosis, severe renal impairment, history of convulsions, and intrathecal, epidural, intraventricular or intracerebral administration.
• Selected pharmacy tablets: hypersensitivity, renal impairment, active or previous thromboembolism with familial thrombophilia, haematuria, irregular menstrual bleeding, pregnancy, history of convulsions, specified fibrinolytic coagulopathies, and use with oral contraceptives or anticoagulants.

Monitoring

• Renal function when impairment is present or suspected.
• New visual disturbance; consider ophthalmological monitoring during continuous long-term injection use.
• Clinical evidence of thrombosis, seizures or hypersensitivity.
• Urinary obstruction in upper urinary-tract haematuria.

Clinical pharmacology

Tranexamic acid is a synthetic lysine analogue that binds plasminogen and inhibits plasmin-mediated fibrinolysis. Elimination is chiefly renal as unchanged medicine.

Formulation and product differences

• The selected tablet is an oral pharmacy product licensed specifically for heavy regular menstrual bleeding in adults.
• The selected injection is prescription-only and licensed for broader fibrinolytic bleeding indications in adults and children from one year.
• The injection is intravenous only and unsuitable for intramuscular, neuraxial or intracranial administration.

Tablet

Route: Oral

Strengths: 500 mg

Injection

Route: Parenteral

Strengths: 100 mg/mL, 500 mg/5 mL