aminocaproic acid

aminocaproic acid

Amicar

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, 1,000 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

• Disseminated intravascular coagulation

• Neonates (injectable form)

Precautions

Use cautiously in:

• heart, hepatic, or renal failure

• upper urinary tract bleeding.

Administration

• Dilute I.V. form in 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

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.

aminocaproic acid

A drug that reduces the tendency for fibrin in the blood to be broken down. It thus aids in the clotting of blood in wounds.