Antifibrinolytic Pregnancy: No evidence of teratogenicity in animal studies; usual caution in pregnancy applies. Crosses the placenta. Passes into breast milk at about one-hundredth of maternal blood concentration; an antifibrinolytic effect in the infant is unlikely.

Tranexamic Acid

Brand names: Cyklokapron, Cyclokapron

Used in: Gastrointestinal Bleeding Head Injury Epistaxis (Nosebleed)

Tranexamic acid is an antifibrinolytic agent used to prevent or treat bleeding, including heavy menstrual bleeding, surgical and traumatic haemorrhage, and mucosal bleeding in patients with bleeding disorders.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Local fibrinolysis: 15-25 mg/kg bodyweight (i.e. 2-3 tablets of 500 mg) two to three times daily

Route: Oral

Frequency: Two to three times daily (varies by indication)

Max: Menorrhagia: total dose of 4 g daily (8 tablets) should not be exceeded

Menorrhagia: 2 tablets (1 g) three times daily for up to 4 days, started only after menstrual bleeding has begun (may increase if very heavy; do not exceed 4 g/day). Prostatectomy: start pre-/post-operatively with IV tranexamic acid, then 2 tablets three to four times daily until macroscopic haematuria resolves. Epistaxis (recurrent): 2 tablets three times daily for 7 days. Conisation of the cervix: 3 tablets three times daily. Traumatic hyphaema: 2-3 tablets three times daily (based on 25 mg/kg three times a day). Hereditary angioneurotic oedema: 2-3 tablets two to three times daily, intermittently or continuously. Haemophilia (dental extraction): 2-3 tablets every 8 hours (based on 25 mg/kg). Elderly: no dose reduction unless renal insufficiency.

Paediatric dose

Dose: 25 mg/kg

Route: Oral

Frequency: Per dose; frequency according to indication (e.g. every 8 hours for dental extraction in haemophilia)

Max: Not specified in the SPC

Children's dose calculated by body weight at 25 mg/kg per dose; data on efficacy, posology and safety for these indications are limited. No clinical experience in menorrhagic children under 15 years.

Dose adjustments

Renal

Reduce oral dose in mild-to-moderate renal insufficiency: serum creatinine 120-249 micromol/l -> 15 mg/kg twice daily; 250-500 micromol/l -> 15 mg/kg once daily. Contraindicated in severe renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Children's dose calculated by body weight at 25 mg/kg per dose; data on efficacy, posology and safety for these indications are limited. No clinical experience in menorrhagic children under 15 years.

Verify in a children's formulary

Contraindications

Severe renal impairment (risk of accumulation)
Hypersensitivity to tranexamic acid or any of the excipients
Active thromboembolic disease
History of venous or arterial thrombosis
Fibrinolytic conditions following consumption coagulopathy
History of convulsions

Side effects

Colour vision disturbances; retinal/artery occlusion (rare)
Thromboembolic events (rare); arterial or venous thrombosis at any site (very rare)
Nausea, vomiting and diarrhoea (very rare; resolve on dose reduction)
Allergic skin reactions (rare); fixed drug eruption
Hypersensitivity reactions including anaphylaxis (very rare); convulsions (particularly in misuse)

Interactions

Fibrinolytic (thrombolytic) preparations: tranexamic acid counteracts their thrombolytic effect
Oral contraceptives: increased risk of thrombosis — administer with care

Clinical monograph

How it works

It is a lysine analogue that reversibly blocks the lysine-binding sites on plasminogen, preventing its conversion to plasmin and thereby inhibiting fibrinolysis to stabilise formed clots.

Prescribing in practice

Avoid in patients with active thromboembolic disease and use caution where there is a high thrombotic risk, as inhibiting clot breakdown may favour thrombosis.
It is contraindicated in disseminated intravascular coagulation unless under specialist guidance and in a history of convulsions for some routes; dose reduction is needed in renal impairment.
In urinary tract bleeding it can cause clot retention and obstruction, so use cautiously in haematuria of upper urinary tract origin.

Monitoring

Monitor the clinical bleeding response and renal function, and remain alert for any features of thromboembolism.

Counselling the patient

For heavy periods, take only during the days of bleeding as directed.
Report calf pain or swelling, chest pain, breathlessness or visual disturbance.
Seek advice if bleeding is not controlled.

Evidence & guidelines

The CRASH-2 trial showed early tranexamic acid reduces death from bleeding in trauma, and it is recommended for heavy menstrual bleeding by NICE.

Reference: CRASH-2 trial (Lancet 2010); WHO PPH guidelines; NICE NG24; 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.

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