Tranexamic acid Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Available preparations

Cyklokapron 500mg per 5ml ampoule

Tranexamic acid 500mg per 5mL ampoule (Bowmed)

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Intravenous infusion (unlicensed BUT preferred due to safety concerns due to risk of rapid administration with alternative routes)^{(ref 1,6)}

Add required dose to a convenient volume and give over at least ten minutes e.g. 100ml sodium chloride 0.9% over 10 minutes

Slow intravenous injection (caution: recommendation of max 100mg/minute makes this route impractical)

Administer required dose at a rate of 1ml per minute (100mg per minute) to minimise harm
Rapid administration may cause hypotension and loss of consciousness ^{(ref 1)}

Dose in adults

Standard treatment of local fibrinolysis:

Give 0.5 to 1g two to three times daily
Important: Maximum rate of administration is 1g over 10 minutes- to avoid Adverse Drug Reactions

Standard treatment of general fibrinolysis:

Give 1g every six to eight hours, equivalent to 15mg per kg body weight
Important: Maximum rate of administration is 1g over 10 minutes- to avoid Adverse Drug Reactions

Significant haemorrhage following trauma (unlicensed indication)^{(ref 2,3)}

Give a 1g dose over 10 minutes, followed by 1g as an intravenous infusion over eight hours
Important: Maximum rate of administration is 1g over 10 minutes- to avoid Adverse Drug Reactions
Do not use intravenous tranexamic acid more than 3 hours after injury in patients with major trauma unless there is evidence of hyperfibrinolysis^{(ref 2)}

Neutralisation of thrombolytic therapy ^{(ref 4)}

Give 10mg per kg
Important: Maximum rate of administration is 1g over 10 minutes- to avoid Adverse Drug Reactions

Disseminated intravascular coagulation (DIC)^{(ref 4)}

A single dose of 1g tranexamic acid is frequently sufficient to control bleeding
Administration of tranexamic acid in DIC should be considered only when appropriate haematological laboratory facilities and expertise are available
Important: Maximum rate of administration is 1g over 10 minutes- to avoid Adverse Drug Reactions

Post-partum haemorrhage (unlicensed indication)

See WAC Group and National Guidelines and Procedures and Pathway for the management of Primary and Secondary Post-partum Haemorrhage (PPH)
Important: Maximum rate of administration is 1g over 10 minutes- to avoid Adverse Drug Reactions

Renal impairment ^{(ref 5)}
GFR (ml per minute/1.73m2)	Dose	Frequency
20 to 50	10mg/kg	every 12 hours
10 to 20	10mg/kg	every 24 hours
less than 10	5mg/kg	every 24 hours

Storage

Store below 25⁰C

References

SPC February 2020

1: Injectable medicines guide Medusa downloaded 08/05/2024

2: NICE 2016 NG39 Major trauma: assessment and initial management

3: UptoDate -accessed online 08/05/2024

4: Martindale accessed online 08/05/2024

5: Renal Drug database accessed online 08/05/2024

6. Conversations with Drs Gilmore and Cosgrave. 18 April 2024. (Peter Kidd).

Therapeutic classification

Antifibrinolytic drug

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