Formulary
Tranexamic acid: Indications, Dosing, Side Effects and Interactions
Tranexamic acid is an antifibrinolytic that prevents or reduces bleeding by impairing fibrin dissolution.
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Tranexamic acid: Indications, Dosing, Side Effects and Interactions
Tranexamic acid is an antifibrinolytic that prevents or reduces bleeding by impairing fibrin dissolution.
Drug action
Tranexamic acid is an antifibrinolytic that prevents or reduces bleeding by impairing fibrin dissolution.
Indications and dose
**Local fibrinolysis**
- **Adult** (By Mouth): 0.5-1 g 2-3 times a day, followed by (by continuous intravenous infusion) 25-50 mg/kg/24 hours, infusion to be given if required.
**Menorrhagia**
- **Adult** (By Mouth): 1 g 3 times a day for up to 4 days, to be initiated when menstruation has started, dose can be increased if necessary up to maximum 4 g per day.
**Hereditary angioedema**
- **Adult** (By Mouth): 1-1.5 g 2-3 times a day, for short-term prophylaxis of hereditary angioedema, tranexamic acid is started several days before planned procedures which may trigger an acute attack of hereditary angioedema (e.g. dental work) and continued for 2-5 days afterwards.
**Epistaxis**
- **Adult** (By Mouth): 1 g 3 times a day for 7 days.
**General fibrinolysis**
- **Adult** (By Slow Intravenous Injection): 1 g every 6-8 hours, alternatively 15 mg/kg every 6-8 hours.
**Prevention and treatment of haemorrhage following head injury [Glasgow Coma Scale score of 12 or less, and without active extracranial bleeding]**
- **Adult** (By Slow Intravenous Injection): 2 g for 1 dose, given as soon as possible within 2 hours of the injury.
**Treatment of postpartum haemorrhage**
- **Adult** (By Slow Intravenous Injection): 1 g for 1 dose, to be repeated if necessary after at least 30 minutes.
**Inhibition of fibrinolysis for tranexamic acid**
- **Child** (By mouth): 15-25 mg/kg 2-3 times a day (max. per dose 1.5 g).
- **Child** (By slow intravenous injection): 10 mg/kg 2-3 times a day (max. per dose 1 g), dose to be given over at least 10 minutes.
- **Child** (By continuous intravenous infusion): 45 mg/kg/24 hours.
**Menorrhagia for tranexamic acid**
- **Child 12-17 years** (By mouth): 1 g 3 times a day for up to 4 days, to be initiated when menstruation has started, dose can be increased if necessary up to maximum 4 g per day.
**Hereditary angioedema for tranexamic acid**
- **Child** (By mouth): 15-25 mg/kg 2-3 times a day (max. per dose 1.5 g), for short-term prophylaxis of hereditary angioedema, tranexamic acid is started several days before planned procedures which may trigger an acute attack of hereditary angioedema (e.g. dental work) and continued for 2-5 days afterwards.
- **Child** (By slow intravenous injection): 10 mg/kg 2-3 times a day (max. per dose 1 g), dose to be given over at least 10 minutes.
- **Child** (By continuous intravenous infusion): 45 mg/kg/24 hours.
**Prevention of excessive bleeding after dental procedures (e.g. in haemophilia) for tranexamic acid**
- **Child 6-17 years** (By intravenous injection): 10 mg/kg for 1 dose (max. per dose 1.5 g), to be given pre-operatively.
- **Child 6-17 years** (By mouth): 15-25 mg/kg for 1 dose (max. per dose 1.5 g), to be given pre-operatively, then 15-25 mg/kg 2-3 times a day (max. per dose 1.5 g) for up to 8 days, to be given postoperatively.
**Prevention of excessive bleeding after dental procedures (e.g. in haemophilia) with mouthwash 5% solution (specialist use only) for tranexamic acid**
- **Child 6-17 years** (By oromucosal administration): 5-10 mL 4 times a day for 2 days, rinse mouth with solution; the solution should not be swallowed.
**Reduction of blood loss during cardiac surgery for tranexamic acid**
- **Child** (By slow intravenous injection, or by intravenous infusion): (consult local protocol).
**Haemorrhage following major trauma for tranexamic acid**
- **Child** (Initially by slow intravenous injection): Loading dose 15 mg/kg (max. per dose 1 g), given as soon as possible within 3 hours of the injury, followed by (by continuous intravenous infusion) 2 mg/kg/hour (max. per dose 1 g) for at least 8 hours or until bleeding stops.
**Prevention and treatment of haemorrhage following head injury [Glasgow Coma Scale score of 12 or less, and without active extracranial bleeding] for tranexamic acid**
- **Neonate** (By slow intravenous injection): 15-30 mg/kg for 1 dose, given as soon as possible within 2 hours of the injury.
- **Child 1 month-15 years** (By slow intravenous injection): 15-30 mg/kg for 1 dose (max. per dose 2 g), given as soon as possible within 2 hours of the injury.
- **Child 16-17 years** (By slow intravenous injection): 2 g for 1 dose, given as soon as possible within 2 hours of the injury.
Cautions
Irregular menstrual bleeding (establish cause before initiating therapy); massive haematuria (avoid if risk of ureteric obstruction); patients receiving oral contraceptives (increased risk of thrombosis) Cautions, further information Menorrhagia Before initiating treatment for menorrhagia, exclude structural or histological causes or fibroids causing distortion of uterine cavity.
Contraindications
Fibrinolytic conditions following disseminated intravascular coagulation (unless predominant activation of fibrinolytic system with severe bleeding); history of convulsions; thromboembolic disease
Side effects
General side-effects: Common or very common Diarrhoea (reduce dose); nausea; vomiting Uncommon Allergic dermatitis Rare or very rare Colour vision change (discontinue); embolism and thrombosis Frequency not known Seizure (more common at high doses); visual impairment (discontinue) Specific side-effects: Frequency not known With intravenous use Hypotension; malaise (on rapid intravenous injection)
Interactions
**Other interactions (1):**
- Simultaneous treatment with anticoagulants must take place under the strict supervision of a physician experienced in this field.
Pregnancy
No evidence of teratogenicity in animal studies; manufacturer advises use only if potential benefit outweighs risk-crosses the placenta.
Breast feeding
Small amount present in milk-antifibrinolytic effect in infant unlikely.
Renal impairment
Dose adjustments Reduce dose-consult product literature for details.
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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