Antifibrinolytic Pregnancy: Available data have not clarified whether there is a drug-associated risk of miscarriage or adverse maternal/foetal outcomes; tranexamic acid crosses the placenta. Use requires an accurate individual risk-benefit evaluation. Women of childbearing potential must use effective contraception during treatment. Limited data in breast-feeding — no final assessment can be established.

Tranexamic Acid (TXA)

Brand names: Cyclokapron, Cyklokapron

Used in: Gastrointestinal Bleeding Head Injury Epistaxis (Nosebleed)

Tranexamic acid is an antifibrinolytic used to reduce bleeding — in trauma, surgery, postpartum haemorrhage and heavy menstrual bleeding.

Adult dose

Dose: Local fibrinolysis: 0.5 g to 1 g. General fibrinolysis: 1 g (equivalent to 15 mg/kg body weight).

Route: Slow intravenous injection only (maximum 1 mL/minute). MUST ONLY be administered intravenously — must not be given intrathecally, epidurally, intraventricularly, intracerebrally or intramuscularly.

Frequency: Local fibrinolysis: two to three times daily. General fibrinolysis: every 6 to 8 hours.

SPC states 'Unless otherwise prescribed, the following doses are recommended'. Elderly: no reduction in dosage necessary unless there is evidence of renal failure. Hepatic impairment: no dose adjustment required. It is strongly recommended to label syringes containing tranexamic acid with the intravenous route, to reduce the risk of fatal medication errors from incorrect route of administration. Source: eMC SPC for Tranexamic Acid 100 mg/mL Solution for Injection, section 4.2.

Paediatric dose

Dose: 20 mg/kg

Route: Slow intravenous injection only (maximum 1 mL/minute)

Frequency: Per day (total daily dose), children from 1 year

Max: Not stated in source

SPC wording: 'In children from 1 year, for current approved indications as described in section 4.1, the dosage is in the region of 20 mg/kg/day. However, data on efficacy, posology and safety for these indications are limited.' Efficacy, posology and safety in children undergoing cardiac surgery have not been fully established. Verify against a children's formulary before use.

Dose adjustments

Renal

Contraindicated in severe renal impairment. Mild to moderate renal impairment — reduce dose by serum creatinine: 120 to 249 micromol/L = 10 mg/kg body weight every 12 hours; 250 to 500 micromol/L = 10 mg/kg body weight every 24 hours; greater than 500 micromol/L = 5 mg/kg body weight every 24 hours.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

US labelling (FDA)

Reference — US labelling, may differ from UK

Before Extraction: Administer 10 mg/kg actual body weight of tranexamic acid injection intravenously with replacement therapy. ( 2.1 ) After Extraction: Administer 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days. Infuse no more than 1 mL/minute to avoid hypotension. ( 2.1 ) Reduce the dosage for patients with renal impairment. ( 2.2 , 8.6 ) 2.1 Recommended Dosage The recommended dose of tranexamic acid injection is 10 mg/kg actual body weight intravenously administered as a single-dose, immediately before tooth extractions. Infuse no more than 1 mL/minute to avoid hypotension [see Warnings and Precautions ( 5.1 )]. Following tooth extraction, tranexamic acid injection may be …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-03-15. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Acute venous or arterial thrombosis
Fibrinolytic conditions following consumption coagulopathy, except in those with predominant activation of the fibrinolytic system with acute severe bleeding
Severe renal impairment (risk of accumulation)
History of convulsions
Intrathecal, epidural, intraventricular injection and intracerebral application (risk of cerebral oedema, convulsions and death)

Side effects

Gastrointestinal: diarrhoea, vomiting, nausea (common)
Malaise with hypotension, with or without loss of consciousness — generally following too fast intravenous injection (uncommon)
Allergic dermatitis; fixed drug eruption (uncommon)
Convulsions, particularly in case of misuse (frequency not known)
Visual disturbances including impaired colour vision; arterial or venous thrombosis at any site; hypersensitivity reactions including anaphylaxis; acute renal cortical necrosis (frequency not known)

Interactions

US labelling (§7.1) states: avoid concomitant use with prothrombotic medical products (e.g. Factor IX Complex concentrates, anti-inhibitor coagulant concentrates, hormonal contraceptives) as this can further increase the risk of thromboembolic adverse reactions — clinician to confirm against the full UK SPC §4.5.
This interaction list may be incomplete — check the full SPC.

Clinical monograph

How it works

It blocks the binding of plasminogen to fibrin, inhibiting fibrinolysis and stabilising formed clots.

Prescribing in practice

In major trauma and postpartum haemorrhage, give it as early as possible — the benefit falls substantially with delay.
Use caution with a history of thromboembolism, and (with high intravenous doses) a risk of seizures.
Dose-reduce in renal impairment.

Monitoring

Assess clinical bleeding/response; in trauma, give within the evidence-based time window.

Counselling the patient

For heavy periods, take it during the heavy days as directed.
Report calf swelling or chest symptoms (possible clot).

Evidence & guidelines

Reduces death from bleeding in trauma and postpartum haemorrhage when given early (CRASH-2, WOMAN) and reduces menstrual blood loss (NICE NG88).

Reference: CRASH-2 Trial, Lancet 2010; WOMAN Trial, Lancet 2017; NICE TA65; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

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Featured in these MRCEM clinical pathways

Tranexamic Acid (TXA) is a core drug in the following exam-focused workups on our sister siteReviseMRCEM.

MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.