What is the recommended dose of Tranexamic Acid (TXA) for adolescents with menorrhagia?

Recommended Dose of Tranexamic Acid for Adolescents with Menorrhagia

The recommended dose of tranexamic acid for adolescents with menorrhagia is 30-50 mg/kg/day in 2-3 divided doses, with a maximum dose of 3-4 g/day. 1

Dosing Guidelines

• For adolescents with menorrhagia, tranexamic acid should be administered at 30-50 mg/kg/day divided into 2-3 doses, with a maximum daily dose of 3-4 g 1
• Treatment should be given for the first 4-5 days of the menstrual cycle, starting from the first day of bleeding 2, 3
• For older adolescents (>12 years), the adult dosing regimen can be followed: starting at 500 mg twice daily, gradually increasing up to 1000 mg 3-4 times daily as needed 1
• For severe cases not responding to standard doses, the dose can be increased up to 1500 mg three times daily (4.5 g/day), though this should be done with caution 2, 3

Clinical Considerations

• Tranexamic acid is recommended as a first-line treatment for menorrhagia in adolescents due to its efficacy and favorable safety profile 2, 3
• It works by inhibiting fibrinolysis, thereby reducing menstrual blood loss by 34-59% over 2-3 cycles 2
• Tranexamic acid is particularly useful in adolescents as it provides non-hormonal management of menorrhagia, which may be preferable in this age group 3
• The medication should be taken only during menstruation, not continuously throughout the month 2, 3

Monitoring and Safety

• Common side effects are primarily gastrointestinal in nature (nausea, vomiting, diarrhea, dyspepsia) occurring in approximately 12% of patients 2
• Contraindications include recent thrombosis; relative contraindications include atrial fibrillation or known thrombophilia 1
• No evidence exists of an increase in the incidence of thrombotic events with proper use of tranexamic acid for menorrhagia 3
• For adolescents with renal impairment, dose adjustment may be necessary as tranexamic acid is primarily eliminated through the kidneys 4

Special Situations

• For adolescents with von Willebrand disease or other bleeding disorders causing menorrhagia, higher doses (up to 3 g daily in four divided doses) may be required for the first 5 days of the menstrual cycle 5
• In cases where oral administration is problematic, alternative routes such as vaginal administration have been studied but are not standard of care 6
• For adolescents with severe menorrhagia requiring intravenous treatment (rare), the dose should be 15 mg/kg followed by infusion at 2 mg/kg/hour 1

Treatment Algorithm

1. Start with tranexamic acid 30-50 mg/kg/day divided into 2-3 doses (maximum 3-4 g/day) for the first 4-5 days of menstruation 1
2. If response is inadequate after 2-3 cycles, increase dose up to maximum of 4.5 g/day (1.5 g three times daily) 2, 3
3. If menorrhagia persists despite maximum dosing, consider additional or alternative treatments such as hormonal therapy 3
4. For adolescents >12 years old, consider using the adult dosing regimen 1

Tranexamic acid has proven to be significantly more effective than placebo, NSAIDs, and oral luteal phase progestins for treating menorrhagia, making it an excellent first-line treatment option for adolescents with this condition 2, 3.