▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child: 45 mg/kg, dose to be given over 24 hours
Menorrhagia
▶BY MOUTH
▶Child 12–17 years: 1 g 3 times a day for up to 4 days, to be
initiated when menstruation has started; maximum 4 g
per day
Hereditary angioedema
▶BY MOUTH
▶Child: 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
▶BY SLOW INTRAVENOUS INJECTION
▶Child: 10 mg/kg 2 – 3 times a day (max. per dose 1 g),
dose to be given over at least 10 minutes
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child: 45 mg/kg, dose to be given over 24 hours
Prevention of excessive bleeding after dental procedures
(e.g. in haemophilia)
▶BY INTRAVENOUS INJECTION
▶Child 6–17 years: 10 mg/kg (max. per dose 1. 5 g), dose to
be given pre-operatively
▶BY MOUTH
▶Child 6–17 years: 15 – 25 mg/kg (max. per dose 1. 5 g),
dose 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,
dose to be given postoperatively
Prevention of excessive bleeding after dental procedures
(e.g. in haemophilia) with mouthwash 5 % solution
(specialist use only)
▶BY MOUTH
▶Child 6–17 years: 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
▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
▶Child:(consult local protocol)lUNLICENSED USENot licensed for reduction of blood loss
during cardiac surgery; injection not licensed for use in
children under 1 year or for administration by intravenous
infusion.
lCONTRA-INDICATIONSFibrinolytic conditions following
disseminated intravascular coagulation (unless
predominant activation offibrinolytic system with severe
bleeding).history of convulsions.thromboembolic
disease
lCAUTIONSIrregular 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
▶MenorrhagiaBefore initiating treatment for menorrhagia,
exclude structural or histological causes orfibroids causing
distortion of uterine cavity.
lINTERACTIONS→Appendix 1 : tranexamic acid
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonDiarrhoea (reduce dose).nausea.
vomiting
▶UncommonAllergic dermatitis
▶Rare or very rareColour vision change (discontinue).
embolism and thrombosis
▶Frequency not knownSeizure (more common at high
doses).visual impairment (discontinue)
SPECIFIC SIDE-EFFECTS
▶With intravenous useHypotension.malaise (on rapid
intravenous injection)
lPREGNANCYNo evidence of teratogenicity inanimal
studies; manufacturer advises use only if potential benefit
outweighs risk—crosses the placenta.
lBREAST FEEDINGSmall amount present in milk—
antifibrinolytic effect in infant unlikely.
lRENAL IMPAIRMENTAvoid in severe impairment.
Dose adjustmentsReduce dose in mild to moderate
impairment.
lMONITORING REQUIREMENTSRegular liver function tests
in long-term treatment of hereditary angioedema.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
administration, dilute with Glucose 5 %orSodium chloride
0. 9 %.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Tranexamic acid for heavy bleeding
during periodswww.medicinesforchildren.org.uk/tranexamic-
acid-for-heavy-bleeding-during-periods
Medicines for Children leaflet: Tranexamic acid for treatment for
prevention of bleedingwww.medicinesforchildren.org.uk/
tranexamic-acid-for-treatment-or-prevention-of-bleedinglMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
▶Tranexamic acid (Non-proprietary)
Tranexamic acid 500 mgTranexamic acid 500 mg tablets|
60 tabletP£ 32. 10 DT = £ 12. 85
▶Cyklokapron(Meda Pharmaceuticals Ltd)
Tranexamic acid 500 mgCyklokapron 500 mg tablets|
60 tabletP£ 14. 30 DT = £ 12. 85
Solution for injection
▶Tranexamic acid (Non-proprietary)
Tranexamic acid 100 mg per 1 mlTranexamic acid 500 mg/ 5 ml
solution for injection ampoules| 5 ampouleP£ 7. 50 (Hospital
only)| 5 ampouleP£ 7. 50 | 10 ampouleP£ 13. 99 – £ 15. 47
(Hospital only)
▶Cyklokapron(Pfizer Ltd)
Tranexamic acid 100 mg per 1 mlCyklokapron 500 mg/ 5 ml solution
for injection ampoules| 10 ampouleP£ 15. 47ANTIHAEMORRHAGICS›HAEMOSTATICS
Emicizumab 09-May-2018
lDRUG ACTIONEmicizumab is a monoclonal antibody that
bridges activated factor IX and factor X to restore function
of missing activated factor VIII, which is needed for
haemostasis.lINDICATIONS AND DOSE
Prophylaxis of haemorrhage in patients with haemophilia
A (initiated by a specialist)
▶BY SUBCUTANEOUS INJECTION
▶Child:Initially 3 mg/kg once weekly for 4 weeks, then
maintenance 1. 5 mg/kg once weekly, administer into
the thigh, abdomen or upper armlCAUTIONSChildren under 1 year.concomitant bypassing
agent.risk factors for thrombotic microangiopathy
CAUTIONS, FURTHER INFORMATION
▶Concomitant bypassing agentManufacturer advises
discontinue bypassing agents the day before starting
emicizumab; if a bypassing agent is required—consult
product literature.
lSIDE-EFFECTS
▶Common or very commonArthralgia.diarrhoea.fever.
headache.myalgia.thrombotic microangiopathyBNFC 2018 – 2019 Bleeding disorders 83
Cardiovascular system2