Pharmacologic class: Carboxylic acid derivative
Therapeutic class: Antihemorrhagic, antifibrinolytic
Pregnancy risk category C
Interferes with plasminogen activator substances and blocks action of fibrinolysin (plasmin)
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.
• Dental extractions
• Hypersensitivity to drug
• Disseminated intravascular coagulation
• Neonates (injectable form)
Use cautiously in:
• heart, hepatic, or renal failure
• upper urinary tract bleeding.
• 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
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
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
• 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.
• 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-mee-noe-ka-pro-ik a-sid) ,
ClassificationTherapeutic: hemostatic agents
Pharmacologic: fibrinolysis inhibitors
Time/action profile (peak blood levels)
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
- nasal stuffiness
- hypotension (IV only)
- renal failure
Drug-Drug interactionConcurrent use with estrogens, conjugated may result in a hypercoagulable state.Concurrent use with clotting factors may ↑ risk of thromboses.
Acute Bleeding Syndromes due to Elevated Fibrinolytic Activity
Prevention of Bleeding Following Oral Surgery in Hemophiliacs
- Monitor BP, pulse, and respiratory status as indicated by severity of bleeding.
- Monitor for overt bleeding every 15–30 min.
- Monitor neurologic status (pupils, level of consciousness, motor activity) in patients with subarachnoid hemorrhage.
- Monitor intake and output ratios frequently; notify physician 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.
- ↑ CPK, AST, and serum aldolase may indicate myopathy.
- May ↑ serum potassium.
Potential Nursing DiagnosesIneffective tissue perfusion (Indications)
Risk for injury (Indications, Side Effects)
- Oral: 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.
- pH: 6–7.6.
- Intravenous: 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.
- Continuous Infusion: 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.
- Y-Site Compatibility: alemtuzumab, alfentanil, amikacin, aminophylline, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, anidulafungin, argatroban, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, ceftazidime, ceftriaxone, cefuroxime, cisatracurium, clindamycin, cyclophosphamide, cyclosporine, cytarabine, daptomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, foscarnet, fosphenytoin, furosemide, gemcitabine, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, levorphanol, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, meropenem, methohexital, methylprednisolone, metoclopramide, metoprolol, metronidazole, milrinone, mitoxantrone, morphine, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, octreotide, ondansetron, oxaliplatin, oxytocin, palonosetron, pamidronate, pantoprazole, pamidronate, pancuronium, pantoprazole, pemetrexed, pentamidine, pentobarbital, phenobarbital, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, promethazine, propranolol, ranitidine, remifentanil, rocuronium, sargramostim, sodium bicarbonate, sodium phosphates, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vincristine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: acyclovir, amiodarone, caspofungin, chlorpromazine, ciprofloxacin, diazepam, dolasetron, doxycycline, filgrastim, ganciclovir, midazolam, mycophenolate, nicardipine, phenytoin, prochlorperazine, quinupristin/dalfopristin, thiopental
- Additive Incompatibility: Do not admix with other medications.
- Instruct patient to notify the nurse immediately if bleeding recurs or if thromboembolic symptoms develop.
- Intravenous: Caution patient to make position changes slowly to avoid orthostatic hypotension.
- Cessation of bleeding.
- Prevention of rebleeding in subarachnoid hemorrhage without occurrence of undesired clotting.