Tranexamic acid Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Available preparations

Cyklokapron 500mg per 5ml ampoule

Tranexamic acid 500mg per 5mL ampoule (Bowmed)

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 administration may cause hypotension and 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)}

• 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)

• See WAC Group and National Guidelines and Procedures and Pathway for the management of Primary and Secondary Post-partum Haemorrhage (PPH) 
• 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 08/05/2024

2: NICE 2016 NG39 Major trauma: assessment and initial management

3: UptoDate -accessed online 08/05/2024

4: Martindale accessed online 08/05/2024

5: Renal Drug database accessed online 08/05/2024

6. Conversations with Drs Gilmore and Cosgrave. 18 April 2024. (Peter Kidd).

Therapeutic classification

Antifibrinolytic drug