Contents:
Routes of administration of tranexamic acid
Dose: 1.5g stat and then 1g TDS
Supply: 500mg tablets (these can be dissolved in warm water for 5 mins to aid administration)
or
500mg/5mls oral suspension (special order)
Acute bleeding syndromes due to elevated fibrinolytic activity refer to BNF or SPC
Notes: If bleeding not subsided after 3 days, increase to 1.5-2g TDS. Discontinue one week after bleeding stops, or reduce to 500mg TDS. If bleeding restarts, consider restarting with a view to continue.
Indication: Fungating cancer
Dose: 500mg/5ml (100mg/1ml 5ml ampoule) TDS PRN
Notes: Soak undiluted 100mg/1ml 5ml ampoule (10% solution) into gauze and apply with pressure for 10 minutes before covering with a dressing.
Indication: Epistaxis
Dose: 500mg/5ml (100mg/1ml 5ml ampoule QDS PRN
Notes: Soak undiluted 100mg/1ml 5ml ampoule (10% solution) into cotton pledget/gauze and insert into affected nostril for 10 minutes.
Indication: Mouth Bleeding
Dose: 500mg/10ml (10ml of 500mg/10 ml mouthwash) or (100mg/1ml 5ml ampoule diluted with 5ml water) QDS PRN
Notes: Use 500mg/10ml (5% solution) mouthwash, 10mls at a time.
If no mouthwash preparation available, dilute 1 x 100mg/1ml, 5ml ampoule with 5mls of water and use as a mouthwash. Ensure safe opening of the glass ampoule.
Swallow after use if swallow is safe.
Can also dissolve tablets in water if no other preparation available.
Indication: Rectal Bleeding
Dose: 5000mg/100ml (dilute 10 x 100mg/1ml 5ml ampoules with 50ml water) OD or BD
Notes: Use 5000mg/100ml (5% solution) and instil as an enema
Indication: Bleeding when unable to swallow, no topical option or iv access
Dose: 1500-2000mg/24 hours (100mg/1ml 5ml ampoules) Conversion from oral to sc: 2:1 conversion (5) over 24 hours via CSCI
Notes: CSCI Tranexamic Acid often given alone, using water for injection as diluent when necessary.
For PRN SC doses less than 500mg can be used SC undiluted (usually loading dose or PRN dose). Larger volumes may need dividing between sites (2ml or more) to avoid site pain and reactions.
Diluent: Tranexamic acid is compatible with sodium chloride 0.9% or water for injection or Glucose 5% (4).
Alternatively, can infuse 500mg-1000mg loading dose S/C in 50mls sodium chloride 0.9% over 20-30 minutes.
Caution in eGFR less than 50.
Indication: Haemoptysis
Dose: 500mg/5ml (100mg/1ml 5ml ampoule undiluted) TDS-QDS
Notes: Use undiluted nebulised.
Indication: Pleural haemorrhage (liaise with respiratory consultant)
Dose: 5000mg/50ml (10 x 100mg/1ml 5ml ampoules undiluted) OD
Notes: Instil intrapleural via thoracic drain once daily, clamping for 1hour. Benefit seen after 1-2 instillations. (Undertaken by, or in discussion with the respiratory team)
Indication: Severe haemorrhage if cannot take orally
Dose: 15mg/kg (100mg/1ml 5ml ampoules) TDS-QDS
Notes: Give over 5-10 minutes IV undiluted at a rate not exceeding 1mL (of a 500mg/5ml solution) per minute.
NB. Rapid administration may cause hypotension and loss of consciousness (6)
Acute reactions to IV administration:- Hypersensitivity reactions including anaphylaxis
- Malaise and hypotension with/without loss of consciousness
- Convulsions
- Impaired vision, blurred vision, impaired colour vision
- Arterial or venous thrombosis
- Diarrhoea, vomiting, nausea
- Dermatitis
In the event of or patient at risk of major haemorrhage
Refer to SPAGG Clinical Guideline for the Management of a Major Catastrophic Bleed for People at the End of Life.
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.