Tranexamic acid (injection)
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Turky Alkathery, M.D. [2]
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Overview
Tranexamic acid (injection) is an antifibrinolytic agent that is FDA approved for the treatment of patients with hemophilia for short-term use (two to eight days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction. Common adverse reactions include abdominal pain, anemia, arthralgia, backache, cramps, musculoskeletal pain, headache, migraine, nasal sinus problem and fatigue.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Indication
- CYKLOKAPRON Injection is indicated in patients with hemophilia for short-term use (two to eight days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction.
Dosage
- Immediately before tooth extraction in patients with hemophilia, administer 10 mg per kg body weight of CYKLOKAPRON intravenously together with replacement therapy.
- Following tooth extraction, intravenous therapy, at a dose of 10 mg per kg body weight three to four times daily, may be used for 2 to 8 days.
- Note: For patients with moderate to severe impaired renal function, the following dosages are recommended:
For intravenous infusion, CYKLOKAPRON Injection may be mixed with most solutions for infusion such as electrolyte solutions, carbohydrate solutions, amino acid solutions, and Dextran solutions. Heparin may be added to CYKLOKAPRON Injection. CYKLOKAPRON Injection should NOT be mixed with blood. The drug is a synthetic amino acid, and should NOT be mixed with solutions containing penicillin.
Single-dose vials and ampules
- Discard CYKLOKAPRON vial or ampule and any remaining portion in the vial/ampule after single use.
- The diluted mixture may be stored for up to 4 hours at room temperature prior to patient administration.
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Tranexamic acid in adult patients.
Non–Guideline-Supported Use
- Dental surgical procedure - Hemophilia - Hemorrhage. [1]
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
The drug has had limited use in pediatric patients, principally in connection with tooth extraction. The limited data suggest that dosing instructions for adults can be used for pediatric patients needing CYKLOKAPRON therapy.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Tranexamic acid in pediatric patients.
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Tranexamic acid in pediatric patients.
Contraindications
CYKLOKAPRON Injection is contraindicated:
- In patients with acquired defective color vision, since this prohibits measuring one endpoint that should be followed as a measure of toxicity.
- In patients with subarachnoid hemorrhage. Anecdotal experience indicates that cerebral edema and cerebral infarction may be caused by CYKLOKAPRON in such patients.
- In patients with active intravascular clotting.
- In patients with hypersensitivity to tranexamic acid or any of the ingredients.
Warnings
Focal areas of retinal degeneration have developed in cats, dogs, and rats following oral or intravenous tranexamic acid at doses between 250 to 1600 mg/kg/day (6 to 40 times the recommended usual human dose) from 6 days to 1 year. The incidence of such lesions has varied from 25% to 100% of animals treated and was dose-related. At lower doses, some lesions have appeared to be reversible.
Limited data in cats and rabbits showed retinal changes in some animals with doses as low as 126 mg/kg/day (only about 3 times the recommended human dose) administered for several days to two weeks.
No retinal changes have been reported or noted in eye examinations in patients treated with tranexamic acid for weeks to months in clinical trials.
However, visual abnormalities, often poorly characterized, represent the most frequently reported postmarketing adverse reaction in Sweden. For patients who are to be treated continually for longer than several days, an ophthalmological examination, including visual acuity, color vision, eye-ground, and visual fields, is advised, before commencing and at regular intervals during the course of treatment. Tranexamic acid should be discontinued if changes in examination results are found.
Convulsions have been reported in association with tranexamic acid treatment, particularly in patients receiving tranexamic acid during cardiovascular surgery and in patients inadvertently given tranexamic acid into the neuraxial system.
PRECAUTIONS
General
- The dose of CYKLOKAPRON Injection should be reduced in patients with renal insufficiency because of the risk of accumulation.
- Ureteral obstruction due to clot formation in patients with upper urinary tract bleeding has been reported in patients treated with CYKLOKAPRON.
- Venous and arterial thrombosis or thromboembolism has been reported in patients treated with CYKLOKAPRON. In addition, cases of central retinal artery and central retinal vein obstruction have been reported.
- Patients with a previous history of thromboembolic disease may be at increased risk for venous or arterial thrombosis.
- CYKLOKAPRON should not be administered concomitantly with Factor IX Complex concentrates or Anti-inhibitor Coagulant concentrates, as the risk of thrombosis may be increased.
- Patients with disseminated intravascular coagulation (DIC), who require treatment with CYKLOKAPRON, must be under strict supervision of a physician experienced in treating this disorder.
- Tranexamic acid may cause dizziness and therefore may influence the ability to drive or use machines.
Adverse Reactions
Clinical Trials Experience
Gastrointestinal disturbances (nausea, vomiting, diarrhea) may occur but disappear when the dosage is reduced. Allergic dermatitis, giddiness, and hypotension have been reported occasionally. Hypotension has been observed when intravenous injection is too rapid. To avoid this response, the solution should not be injected more rapidly than 1 mL per minute.
Postmarketing Experience
Worldwide Postmarketing Reports
Thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism, cerebral thrombosis, acute renal cortical necrosis, and central retinal artery and vein obstruction) have been rarely reported in patients receiving tranexamic acid for indications other than hemorrhage prevention in patients with hemophilia. Convulsion, chromatopsia, and visual impairment have also been reported. However, due to the spontaneous nature of the reporting of medical events and the lack of controls, the actual incidence and causal relationship of drug and event cannot be determined.
Drug Interactions
No studies of interactions between CYKLOKAPRON and other drugs have been conducted.
Use in Specific Populations
Pregnancy
Pregnancy Category (FDA): B
There are no adequate and well-controlled studies in pregnant women. However, tranexamic acid is known to pass the placenta and appears in cord blood at concentrations approximately equal to maternal concentration. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Pregnancy Category (AUS):
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Tranexamic acid (injection) in women who are pregnant.
Labor and Delivery
See above under Pregnancy.
Nursing Mothers
Tranexamic acid is present in the mother's milk at a concentration of about a hundredth of the corresponding serum levels. Caution should be exercised when CYKLOKAPRON is administered to a nursing woman.
Pediatric Use
The drug has had limited use in pediatric patients, principally in connection with tooth extraction. The limited data suggest that dosing instructions for adults can be used for pediatric patients needing CYKLOKAPRON therapy.
Geriatic Use
Clinical studies of CYKLOKAPRON did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function
Gender
There is no FDA guidance on the use of Tranexamic acid (injection) with respect to specific gender populations.
Race
There is no FDA guidance on the use of Tranexamic acid (injection) with respect to specific racial populations.
Renal Impairment
The dose of CYKLOKAPRON Injection should be reduced in patients with renal insufficiency because of the risk of accumulation.
Hepatic Impairment
There is no FDA guidance on the use of Tranexamic acid (injection) in patients with hepatic impairment.
Females of Reproductive Potential and Males
Reproduction studies performed in mice, rats, and rabbits have not revealed any evidence of impaired fertility or adverse effects on the fetus due to tranexamic acid.
Immunocompromised Patients
There is no FDA guidance one the use of Tranexamic acid (injection) in patients who are immunocompromised.
Administration and Monitoring
Administration
- Intravenous.
Monitoring
- Monitor renal function in elderly patients because they are more likely to have decreased renal function, care should be taken in dose selection.
IV Compatibility
There is limited information regarding the compatibility of Tranexamic acid (injection) and IV administrations.
Overdosage
Cases of overdosage of CYKLOKAPRON have been reported. Based on these reports, symptoms of overdosage may be gastrointestinal, e.g., nausea, vomiting, diarrhea; hypotensive, e.g., orthostatic symptoms; thromboembolic, e.g., arterial, venous, embolic; neurologic, e.g., visual impairment, convulsions, headache, mental status changes; myoclonus; and rash.
Pharmacology
There is limited information regarding Tranexamic acid (injection) Pharmacology in the drug label.
Mechanism of Action
There is limited information regarding Tranexamic acid (injection) Mechanism of Action in the drug label.
Structure
There is limited information regarding Tranexamic acid (injection) Structure in the drug label.
Pharmacodynamics
There is limited information regarding Tranexamic acid (injection) Pharmacodynamics in the drug label.
Pharmacokinetics
There is limited information regarding Tranexamic acid (injection) Pharmacokinetics in the drug label.
Nonclinical Toxicology
There is limited information regarding Tranexamic acid (injection) Nonclinical Toxicology in the drug label.
Clinical Studies
There is limited information regarding Tranexamic acid (injection) Clinical Studies in the drug label.
How Supplied
There is limited information regarding Tranexamic acid (injection) How Supplied in the drug label.
Storage
There is limited information regarding Tranexamic acid (injection) Storage in the drug label.
Images
Drug Images
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Package and Label Display Panel
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Patient Counseling Information
There is limited information regarding Tranexamic acid (injection) Patient Counseling Information in the drug label.
Precautions with Alcohol
Alcohol-Tranexamic acid interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
There is limited information regarding Tranexamic acid (injection) Brand Names in the drug label.
Look-Alike Drug Names
There is limited information regarding Tranexamic acid (injection) Look-Alike Drug Names in the drug label.
Drug Shortage Status
Price
References
The contents of this FDA label are provided by the National Library of Medicine.
- ↑ Sindet-Pedersen S, Stenbjerg S, Ingerslev J (1988). "Control of gingival hemorrhage in hemophilic patients by inhibition of fibrinolysis with tranexamic acid". J Periodontal Res. 23 (1): 72–4. PMID 2963908.