Antifibrinolytic agent (haemostatic) Pregnancy: Use with caution — limited data; appears safe in short courses for menorrhagia but avoid in first trimester if possible.

Tranexamic Acid 500mg Tablets (Epistaxis)

Brand names: Cyklokapron, Tranexamic acid generic

Adult dose

Dose: Oral: 1–1.5 g (2–3 × 500 mg) three times daily for up to 5–7 days. Topical: 500 mg/5 mL solution applied to nasal mucosa as soaked gauze/pledget

Route: Oral or topical intranasal

Frequency: Three times daily (oral); as required (topical)

Max: 4.5 g/day (oral)

Epistaxis: oral tranexamic acid 1 g TDS for 5–7 days as adjunct to anterior nasal packing or cauterisation. Topical use: 500 mg/5 mL solution (injectable preparation used off-label intranasally) — soaked pledget or spray; evidence shows efficacy comparable to anterior packing for anterior epistaxis. Particularly useful in: hereditary haemorrhagic telangiectasia (HHT/Osler-Weber-Rendu), warfarin-associated epistaxis.

Paediatric dose

Dose: 15 mg/kg

Route: Oral

Frequency: Three times daily

Max: 1.5 g/dose

Children (>1 year): 15–25 mg/kg three times daily (max 1.5 g per dose). Used in von Willebrand disease and HHT-related epistaxis in children. Topical application in children: specialist guidance.

Dose adjustments

Renal

eGFR 40–60: 1 g twice daily. eGFR 20–40: 500 mg twice daily. eGFR 10–20: 500 mg once daily. Avoid if eGFR <10.

Hepatic

No dose adjustment required.

Paediatric weight-based calculator

Patient weight (kg)

Children (>1 year): 15–25 mg/kg three times daily (max 1.5 g per dose). Used in von Willebrand disease and HHT-related epistaxis in children. Topical application in children: specialist guidance.

Clinical pearls

Topical tranexamic acid is evidence-based for acute anterior epistaxis — comparable to anterior packing and less traumatic
Particularly useful in anticoagulated patients (warfarin, DOAC) — reduces bleeding without reversing anticoagulation
HHT (Osler-Weber-Rendu): oral tranexamic acid is first-line pharmacological therapy for recurrent epistaxis
Widely used in trauma and surgery — ENT application is one of many uses
Ensure patient has no contraindications to antifibrinolytics before prescribing (check thrombosis history)

Contraindications

History of thromboembolic disease (DVT, PE, arterial thrombosis) — relative contraindication
Haematuria originating from upper urinary tract (risk of obstructive clot in ureters)
Subarachnoid haemorrhage (risk of cerebral vasospasm)
Hypersensitivity to tranexamic acid

Side effects

Nausea, vomiting, diarrhoea
Thromboembolic events (rare at low doses; increased risk with high doses / predisposed patients)
Hypotension with rapid IV administration
Seizures (rare — CNS effect at very high doses or IV)
Visual disturbance (rare)

Interactions

Hormonal contraceptives — additive thrombotic risk
Factor IX complex / anti-inhibitor coagulant concentrates — avoid combination (thrombosis risk)
All-trans retinoic acid (ATRA) — increased thrombotic risk in APL treatment

Monitoring

Epistaxis resolution
Coagulation screen if recurrent epistaxis or anticoagulated
Renal function

Reference: BNFc; BNF; NICE CKS Epistaxis; ENT-UK Epistaxis Guidelines; BMJ Evidence on Topical TXA. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways