Parenteral Manual

Tranexamic acid

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
CYKLOKAPRON®
Classification: 
Antifibrinolytic Agent
Original Date: 
August 2005
Revised Date: 
February 2020
Indications: 
  • Used to prevent excessive bleeding when hyperfibrinolysis is present
  • Tooth extraction in hemophiliacs (in combination with antihemophiliac factor)
  • Bleeding after surgical procedures such as tonsillectomy and adenoidectomy
  • Management of massive bleeding
Reconstitution and Stability: 
  • Available as a 100 mg/mL injection
  • Stable at room temperature                                                                 
Compatibility: 

- Solutions Compatible: D5W, 0.9%NS, dextrose-saline combinations

- Incompatible: penicillin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct YES
Usual dilution: 100 mg/mL
Infusion time: 5 - 10 minutes
Infusion rate: do not exceed 100 mg/minute
IV Intermittent Infusion YES
Usual dilution: 10 mg/mL
Infusion time: 15-30 minutes
Infusion rate: do not exceed 100 mg/minute
IV Continuous Infusion

YES - in ED or PICU

Usual dilution: 10  mg/mL,  100 mg/mL

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:
- Prior to procedure or Dental surgery :

  • 7-10 mg/kg/dose IV pre-procedure and then TID-QID until able to take oral medication
     

- Cardiac surgery:

  • 50-100 mg/kg IV at beginning of procedure
  • Infusion of 10 mg/kg introperatively has been used  
     

- Management of massive bleeding:

  • Loading dose: 15 mg/kg/dose, MAX 1 g followed by 1.5 - 5 mg/kg/hr (MAX 125 mg/hr) for the lesser of 8 hours or until bleeding stops.
  • Note: Higher doses have been reported in the literature as follows: 30 mg/kg/dose, MAX 2 g  followed by 10 mg/kg/hr, MAX 125 mg/hr for the lesser of 8 hours or until bleeding stops

                     

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

Renal Impairment

Dose 

Mild

Change interval to Q12h or give 50% of standard dose

Moderate

Change interval to Q24h or give 25% of standard dose

Severe

Change interval to Q48h or give 10% of standard dose

Potential hazards of parenteral administration: 
  • Hypotension with rapid IV                                     
  • Nausea, vomiting, diarrhea and abdominal pain (more common with oral therapy)                             
  • CNS effects such as  headache and hydrocephalus
  • Coagulation defects
  • Thromboembolic complications are infrequent
  • Visual abnormalities
Notes: 
  • Contraindicated in subarachnoid hemorrhage, acquired defective colour vision, active intravascular clotting process
  • Use with caution in renal impairment
  • Opthalmologic exams during chronic therapy (e.g. several weeks of therapy)

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