aminocaproic acid (
mē´nōkprō´ik),drug class: hemostatic;
action: inhibits fibrinolysis by inhibiting plasminogen activator substances;
uses: hemorrhage from hyperfibrinolysis; adjunctive therapy in hemophilia; unapproved, hemorrhage following dental surgery in hemophilia.
aminocaproic acid Warning - High-alert drug!
Pharmacologic class: Carboxylic acid derivative
Therapeutic class: Antihemorrhagic, antifibrinolytic
Pregnancy risk category C
Action
Interferes with plasminogen activator substances and blocks action of fibrinolysin (plasmin)
Availability
Injection: 250 mg/ml
Syrup: 250 mg/ml
Tablets: 500 mg
⊘Indications and dosages
➣ Excessive bleeding caused by fibrinolysis
Adults: 5 g P.O. during first hour; then 1 to 1.25 g/hour until drug blood level of 0.13 mg/ml is reached and sustained and bleeding is controlled. Or 4 to 5 g in 250 ml of compatible diluent I.V. over 1 hour, followed by continuous infusion of 1 g/hour in 50 ml of diluent. Continue for 8 hours or until bleeding stops. Maximum daily dosage is 30 g.
Off-label uses
• Dental extractions
• Hemorrhage
Contraindications
• Hypersensitivity to drug
• Upper urinary tract bleeding
• Disseminated intravascular coagulation
• Neonates (injectable form)
Precautions
Use cautiously in:
• heart, hepatic, or renal failure.
Administration
• Dilute I.V. form in sterile water for injection, normal saline solution, dextrose 5% in water, or Ringer's solution for injection. Give at prescribed rate.
• Know that oral and I.V. doses are the same.
| Route | Onset | Peak | Duration |
| P.O. | 1 hr | 2 hr | Unknown |
| I.V. | 1 hr | Unknown | 3 hr |
Adverse reactions
CNS: dizziness, malaise, headache, delirium, hallucinations, weakness, seizures
CV: hypotension, ischemia, thrombophlebitis, cardiomyopathy, bradycardia, arrhythmias
EENT: conjunctival suffusion, tinnitus, nasal congestion
GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia
GU: intrarenal obstruction, renal failure
Hematologic: bleeding tendency, generalized thrombosis, agranulocytosis, leukopenia, thrombocytopenia
Musculoskeletal: myopathy, rhabdomyolysis
Respiratory: dyspnea, pulmonary embolism
Skin: rash, pruritus
Interactions
Drug-drug. Estrogens, hormonal contraceptives: increased risk of hypercoagulation
Activated prothrombin, prothrombin complex concentrates: increased signs of active intravascular clotting
Drug-diagnostic tests. Alanine aminotransferase, aldolase, aspartate aminotransferase, blood urea nitrogen, creatinine, creatine kinase, potassium: increased levels
Drug-herbs. Alfalfa, anise, arnica, astragalus, bilberry, black currant seed oil, capsaicin, cat's claw, celery, chaparral, clove oil, dandelion, dong quai, evening primrose oil, feverfew, garlic, ginger, ginkgo, papaya extract rhubarb, safflower oil, skullcap: increased anticoagulant effect
Coenzyme Q10, St. John's wort: reduced anticoagulant effect
Patient monitoring
• Monitor vital signs, fluid intake and output, and ECG.
☞ Assess for signs and symptoms of thrombophlebitis and pulmonary embolism.
☞ Monitor neurologic status, especially for signs of impending seizure.
• Monitor kidney and liver function test results, serum electrolyte levels, and CBC with white cell differential.
• Evaluate for blood dyscrasias, particularly bleeding tendencies.
Patient teaching
• Tell patient that drug may significantly affect many body systems. Assure him that he'll be monitored closely.
☞ Instruct patient to immediately report signs and symptoms of thrombophlebitis, pulmonary embolism, or unusual bleeding.
• Tell patient he'll undergo frequent blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.
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