Who can administer
May be administered by registered competent doctor or nurse/midwife
Available preparations
Cyklokapron 500mg per 5ml ampoule
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 intravenous injection may cause malaise and hypotension, with or without 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)
- Tranexamic acid should only be used in the treatment of DIC when the condition is predominantly due to disturbances in fibrinolytic mechanisms, not with predominant activation of the coagulation system
- 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) (ref 7)
- Give 1g dose within 3 hours of birth
- May give a second dose of 1g if bleeding continues after 30 minutes
- 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 20/01/2022
2: NICE 2016 NG39 Major trauma: assessment and initial management
3: UptoDate -accessed online 20/01/2022
4: Martindale accessed online 20/01/2022
5: Renal Drug database accessed online 20/01/2022
6. Conversations with Drs Gilmore and Cosgrave. 18 April 2024. (Peter Kidd).
7. Updated WHO recommendation on tranexamic acid for the treatment of post-partum haemorrhage, October 2017
Therapeutic classification
Antifibrinolytic drug