Tranexamic Acid: Brands, Price & Uses in Bangladesh

Tranexamic Acid is an antifibrinolytic medicine used to prevent or reduce excessive bleeding in a range of clinical situations. Evidence and approval status vary by formulation (oral tablet vs. intravenous injection) and by indication:

• Heavy menstrual bleeding (menorrhagia): A well-established oral indication for cyclic heavy menstrual bleeding, taken only during the days of heaviest flow.
• Short-term prophylaxis in hemophilia: Established use (oral and intravenous) to reduce bleeding during and after tooth extraction in patients with hemophilia, usually combined with clotting factor replacement.
• Postpartum hemorrhage and trauma-related bleeding: Recommended by the WHO and supported by large trials (the WOMAN trial for postpartum hemorrhage and CRASH-2 for trauma) for intravenous use under hospital supervision, ideally started as early as possible after bleeding onset.
• Surgical bleeding: Used peri-operatively (e.g., cardiac, orthopedic, dental surgery) under specialist supervision to reduce blood loss and transfusion needs.
• Hereditary angioedema: Used per some guidelines as short-term or prophylactic therapy under specialist supervision when first-line agents are unavailable.

Use of Tranexamic Acid for indications other than heavy menstrual bleeding, especially the injectable form, should always be directed and supervised by a physician in a clinical setting.

Dosage of Tranexamic Acid depends on the indication, formulation (oral vs. intravenous), age, and kidney function. The following is general information; the prescribing physician's instructions always take priority.

Heavy menstrual bleeding (oral, adults): Typically 1300 mg three times daily for up to 5 days during monthly menstruation, starting once bleeding begins. Some regional products use 1 g (two 500 mg tablets) three times daily for up to 4 days as an alternative regimen - follow the specific product's approved dosing.

Short-term prophylaxis in hemophilia (dental extraction): Oral: approximately 25 mg/kg two to three times daily, started shortly before surgery and continued for 2-8 days. Intravenous: 10 mg/kg immediately before extraction, then 10 mg/kg three to four times daily for 2-8 days, usually combined with clotting factor replacement therapy.

Postpartum hemorrhage / trauma-related bleeding (IV, hospital use only): A commonly used protocol is 1 g given by slow intravenous injection, with a second 1 g dose if bleeding continues after 30 minutes; ideally administered within 3 hours of bleeding onset (trauma) or promptly after diagnosis (postpartum hemorrhage). This must only be given by trained healthcare professionals in a clinical setting.

General surgical or other bleeding (adult): 500 mg-1 g (oral or IV as appropriate) two to three times daily, or as directed by the treating physician.

Pediatric dosing: Generally around 10 mg/kg per dose, two to three times daily (oral or IV, per indication), adjusted by a pediatrician for age, weight, and clinical situation.

Renal impairment (dose reduction required): Because Tranexamic Acid is excreted mainly by the kidneys, dosing frequency must be reduced according to renal function: mild impairment generally allows twice-daily dosing, moderate impairment once-daily dosing, and severe impairment dosing as infrequently as every 48 hours or as specifically directed by a nephrologist or physician. Exact renal dose-adjustment intervals vary by formulation and reference source - the prescribing physician or pharmacist should confirm the correct interval based on the patient's calculated creatinine clearance.

Most people tolerate Tranexamic Acid well. Reported side effects include:

• Common: Nausea, vomiting, diarrhea, abdominal discomfort, headache, back pain, muscle or joint pain, and mild dizziness.
• Less common: Fatigue, nasal congestion, skin rash or itching, and, with the injection, discomfort or mild hypotension if given too quickly.
• Rare but serious: Visual disturbances (blurred vision, changes in color perception) with prolonged use; hypersensitivity or allergic reactions; and, rarely, thromboembolic events such as deep vein thrombosis or pulmonary embolism - see Contraindications and Precautions and Warnings.

Seek prompt medical attention for symptoms such as leg swelling or pain, chest pain, shortness of breath, sudden vision changes, or signs of an allergic reaction while taking Tranexamic Acid.