aminocaproic acid

REMS

Treatment of acute, life-threatening hemorrhage due to systemic hyperfibrinolysis or urinary fibrinolysis.

Unlabeled Use:

Prevention of recurrent subarachnoid hemorrhage.
Prevention of bleeding following oral surgery in hemophiliacs.
Management of severe hemorrhage caused by thrombolytic agents.

Action ⬆ ⬇

Inhibits activation of plasminogen.

Therapeutic effects:

Inhibition of fibrinolysis.
Stabilization of clot formation.

Pharmacokinetics ⬆ ⬇

Absorption: Rapidly absorbed following oral administration.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Mostly eliminated unchanged by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2 hr	N/A
IV	unknown	2 hr	N/A

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Active intravascular clotting.

Use Cautiously in:

Upper urinary tract bleeding;
Cardiac, renal, or liver disease (dose ↓ may be required);
Disseminated intravascular coagulation (should be used concurrently with heparin);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Do not use products containing benzyl alcohol with neonates.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias, hypotension (IV only)

EENT: nasal stuffiness, tinnitus

GI: anorexia, bloating, cramping, diarrhea, nausea

GU: diuresis, renal failure

MS: myopathy

Neuro: dizziness, malaise

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with estrogens, conjugated may result in a hypercoagulable state.
Concurrent use with clotting factors may ↑ risk of thromboses.

Route/Dosage ⬆ ⬇

Acute Bleeding Syndromes due to Elevated Fibrinolytic Activity

PO (Adults ): 5 g during the 1st hr, followed by 1–1.25 g every hr for 8 hr or until hemorrhage is controlled; or 6 g over 24 hr after prostate surgery (not to exceed 30 g/day).
IV (Adults ): 4–5 g over 1st hr, followed by 1 g/hr for 8 hr or until hemorrhage is controlled; or 6 g over 24 hr after prostate surgery (not to exceed 30 g/day).
PO IV (Children ): 100 mg/kg or 3 g/m² over 1st hr, followed by continuous infusion of 33.3 mg/kg/hr; or 1 g/m²/hr (total dose not to exceed 18 g/m²/24 hr).

Subarachnoid Hemorrhage

PO (Adults ): To follow IV: 3 g every 2 hr (36 g/day). If no surgery is performed, continue for 21 days after bleeding stops; then ↓ to 2 g every 2 hr (24 g/day) for 3 days; then 1 g every 2 hr (12 g/day) for 3 days.
IV (Adults ): 36 g/day for 10 days followed by PO.

Prevention of Bleeding Following Oral Surgery in Hemophiliacs

PO (Adults ): 75 mg/kg (up to 6 g) immediately after procedure; then every 6 hr for 7–10 days; syrup may also be used as an oral rinse of 1.25 g (5 mL) 4 times a day for 7–10 days.
IV PO (Children ): Also for epistaxis: 50–100 mg/kg/dose administered IV every 6 hr for 2–3 days starting 4 hr before the procedure. After completion of IV therapy, aminocaproic acid should be given as 50–100 mg/kg/dose orally every 6 hr for 5–7 days.

Availability ⬆ ⬇

(Generic available)

Tablets: 500 mg; 1000 mg
Oral syrupraspberry flavor: 1.25 g/5 mL
Solution for injection: 250 mg/mL

Assessment ⬆ ⬇

Monitor for ↓ BP, pulse (bradycardia and arrhythmias), and respiratory status as indicated by severity of bleeding.
Monitor for overt bleeding every 15–30 min during acute bleed and periodically during therapy.
Monitor neurologic status (pupils, level of consciousness, motor activity) in patients with subarachnoid hemorrhage.
Monitor intake and output ratios frequently; notify health care professional if significant discrepancies occur.
Assess for thromboembolic complications (especially in patients with history). Notify health care professional of positive Homans’ sign, leg pain and edema, hemoptysis, dyspnea, or chest pain.

Lab Test Considerations:

Monitor platelet count and clotting factors prior to and periodically throughout therapy in patients with systemic fibrinolysis.
- Monitor BUN and serum creatinine
- ↑CK may indicate myopathy.
- May ↑ serum potassium.

Implementation ⬆ ⬇

PO: Syrup may be used as an oral rinse, swished for 30 sec 4 times/day for 7–10 days for the control of bleeding during dental and oral surgery in hemophilic patients. Small amounts may be swallowed, except during 1st and 2nd trimesters of pregnancy. Syrup may be applied with an applicator in children or unconscious patients.

IV Administration:

IV: Stabilize IV catheter to minimize thrombophlebitis. Monitor site closely.
Intermittent Infusion: Diluent: Do not administer undiluted. Dilute initial 4–5 g dose in 250 mL of sterile water for injection, 0.9% NaCl, D5W, or LR. Do not dilute with sterile water in patients with subarachnoid hemorrhage.Concentration: 20 mg/mL.
Rate: Single doses: Administer over 1 hr. Rapid infusion rate may cause hypotension, bradycardia, or other arrhythmias.
Administer IV solution using infusion pump to ensure accurate dose. Administer via slow IV infusion.
Rate: Initial dose may be followed by a continuous infusion of 1–1.25 g/hr in adults or 33.3 mg/kg/hr in children.

Patient/Family Teaching ⬆ ⬇

Explain purpose of aminocaproic acid to patient.
Instruct patient to notify health care professional of all Rx, OTC medications, vitamins, or herbal products being taken.
Teach patient about signs and symptoms of bleeding (bleeding gums, nosebleed, unusual bruising, hematuria, black tarry stools) and to notify a health care professional immediately.
Instruct patient to notify a health care professional if thromboembolic symptoms develop.
Advise patient to notify a health care professional immediately if a severe headache occurs, especially in patients with a history of subarachnoid hemorrhage.
Advise patient to inform health care professional of medication regimen before treatment or surgery.
IV: Caution patient to make position changes slowly to avoid orthostatic hypotension.
Rep: Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇