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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.