TRIETAM

Indications

• Menorrhagia
• Preventing bleeding in surgical procedures
• Capillary fragility
• Bleeding disorders

Dosage

Children: For paediatric patients, refer to the BNF for Children for appropriate dosing recommendations.

Adults: The usual adult dosage for ethamsylate is 500 mg taken three times daily, adjusted according to the severity of the condition and clinical response. Maximum doses may vary based on clinical guidelines.

Mechanism of action

Ethamsylate works by promoting the stability of capillary membranes and enhancing the aggregation of platelets. It is thought to inhibit the release of certain substances from platelets that can lead to vasodilation and increased permeability of blood vessels, thus reducing bleeding.

Pharmacodynamics

Ethamsylate exhibits hemostatic properties by acting on the microcirculation, helping to prevent excessive blood loss. It does not affect the coagulation factors or the platelet count but enhances the clotting process by acting on the vascular endothelial cells and platelets.

Pharmacokinetics

Ethamsylate is well absorbed after oral administration, with peak plasma concentrations occurring within 1 to 2 hours. It is metabolized in the liver and excreted primarily through the kidneys. The half-life of ethamsylate is approximately 2 to 4 hours. It is important to monitor renal function in patients receiving ethamsylate, as renal impairment may affect its clearance.

Contra-indications

• Hypersensitivity to ethamsylate or any component of the formulation
• Active or history of thrombosis
• Severe renal impairment

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Headache
• Dizziness
• Rash
• Urticaria
• Hypotension

Interactions

• Concurrent use with anticoagulants may increase the risk of thrombosis
• Caution with other medications that may affect coagulation

Precautions

• Use with caution in patients with a history of thromboembolic events
• Monitor renal function in patients with renal impairment
• Caution in patients with a history of allergic reactions

Pregnancy

Ethamsylate should be used in pregnancy only if clearly needed, after assessing the benefits against risks.

Breast-feeding

Ethamsylate is excreted in breast milk; caution is advised when administered to breastfeeding women.

Storage

Store in a cool, dry place, protected from light. Keep out of reach of children.

Formulations

• Tablets
• Injectable solution

Indications

• Heavy menstrual bleeding (menorrhagia)
• Surgical procedures to reduce blood loss
• Trauma-related bleeding
• Hereditary angioedema
• Dental procedures in patients with bleeding disorders

Dosage

Children: Refer to the BNF for Children for specific dosing guidelines based on age, weight, and indication.

Adults: Refer to the BNF for specific dosing guidelines based on indication and patient condition.

Mechanism of action

Tranexamic acid competitively inhibits the lysine binding sites on plasminogen, preventing its conversion to plasmin. This inhibition decreases fibrinolysis, leading to increased clot stability and reduced bleeding.

Pharmacodynamics

The primary pharmacodynamic effect of tranexamic acid is its ability to reduce bleeding by stabilizing fibrin clots. The drug exhibits a dose-dependent effect on clotting, with higher doses leading to a more pronounced antifibrinolytic effect. Tranexamic acid does not significantly affect platelet function or coagulation factors.

Pharmacokinetics

Tranexamic acid is rapidly absorbed after oral administration, with peak plasma concentrations occurring within 1 to 3 hours. It has a bioavailability of approximately 30% to 50%. The drug is primarily excreted unchanged in the urine, with a half-life of approximately 2 hours. It does not undergo significant metabolism in the liver, which is beneficial in patients with hepatic impairment.

Contra-indications

• Active venous thromboembolism
• History of thromboembolic disorders
• Severe renal impairment
• Hypersensitivity to tranexamic acid or any excipients

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Dizziness
• Headache
• Visual disturbances
• Thrombosis
• Hypotension
• Allergic reactions

Interactions

• Anticoagulants (increased risk of thrombosis)
• Hormonal contraceptives (increased risk of thrombosis)
• Fibrinolytics (increased risk of bleeding)

Precautions

• Monitor for signs of thrombosis during treatment
• Use with caution in patients with a history of seizures
• Caution in patients with renal impairment
• Assess the risk of bleeding before use

Pregnancy

Tranexamic acid should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Tranexamic acid is excreted in breast milk; caution should be exercised when administered to nursing mothers.

Storage

Store at room temperature, away from moisture and direct sunlight. Keep out of reach of children.

Formulations

• Tablets
• Injection solution