Tranexamic acid is available in 10-mL single-dose ampuls and vials.2886 Each mL contains 100 mg tranexamic acid in water for injection.2886
Tranexamic acid also is available as a single-dose, premixed, ready-to-use solution of tranexamic acid 1000 mg in a flexible polymeric bag.2888 Each 100-mL bag also contains sodium chloride 700 mg in water for injection.2888
pH
Both tranexamic acid injection in ampuls and vials and tranexamic acid premixed, ready-to-use solution in sodium chloride 0.7% have pH values ranging from 6.5 to 8.2886; 2888
Trade Name(s)
Cyklokapron
The manufacturer recommends that tranexamic acid be administered intravenously at a rate that does not exceed 100 mg/min.2886; 2888
The drug also has been administered as a loading dose infused over 10 minutes, followed by an infusion administered over 8 hours.2889; 2890; 2891
Tranexamic acid is a potent neurotoxin;3618 the drug is not approved or recommended for neuraxial administration.2886; 2888 There have been numerous reports of accidental intraspinal administration of tranexamic acid, often involving confusion with similarly-appearing vials or ampuls of local anesthetics being used for regional anesthesia; such accidental intraspinal administration of tranexamic acid has a mortality rate exceeding 50% and is associated with a high incidence of permanent neurologic injury and paraplegia in survivors.3616; 3617; 3618; 3619 Numerous strategies have been recommended to prevent such errors (e.g., storing tranexamic acid vials and ampuls separate from other drugs [particularly local anesthetics] and with their labels visible, purchasing vials from different manufacturers to minimize look-alike vials, placing labels that read “Contains Tranexamic Acid” over the vial caps, using barcode scanning).3616; 3617; 3618; 3619 Care should be taken to ensure that the correct drug product, dose, and administration procedures are used and that no confusion with other products occurs.3616; 3617; 3618; 3619
Intact containers of tranexamic acid should be stored at controlled room temperature.2886; 2888
Intact containers of tranexamic acid should be visually inspected for particulate matter and discoloration.2886; 2888 Containers are for single-dose use; any unused portion should be discarded.2886; 2888
The manufacturer states that a diluted mixture of tranexamic acid may be stored for up to 4 hours at room temperature prior to administration.2886
In one study, antifibrinolytic activity of tranexamic acid was retained after ampuls were stored at temperatures ranging from -20 to 50°C for up to 12 weeks; however, all ampuls stored at -20°C were visibly cracked within 1 week.2988
Standardize 4 Safety
One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.
Table 1: Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Tranexamic Acid3635
| Patient Population | Concentration Standards | Dosing Units |
|---|---|---|
| Pediatric patients (50 kg) | 100 mg/mL (straight drug) | mg/kg/hour |
For a list of references cited in the text of this monograph, search the monograph titled References.