Pediatric Dosing of Tranexamic Acid
The recommended pediatric dose of tranexamic acid is 15 mg/kg as a loading dose followed by 2 mg/kg/hour as an infusion for trauma and surgery. 1, 2
Intravenous Dosing by Clinical Scenario
Trauma and Surgery
- Loading dose: 15 mg/kg IV 1, 2
- Maintenance infusion: 2 mg/kg/hour for up to 8 hours 1, 2
- This dosing regimen is particularly recommended for pediatric trauma patients with risk of significant hemorrhage 2
- For hemophilia patients undergoing tooth extraction, 10 mg/kg immediately before extraction, followed by 10 mg/kg 3-4 times daily for 2-8 days 3
Menorrhagia in Adolescents
- 30-50 mg/kg/day divided into 2-3 doses (maximum daily dose: 3-4 g) 4
- For older adolescents (>12 years): Start at 500 mg twice daily, gradually increasing to 1000 mg 3-4 times daily as needed 4
- For severe cases requiring IV treatment: 15 mg/kg followed by 2 mg/kg/hour infusion 4
Dose Adjustments for Special Populations
Renal Impairment
- For moderate to severe renal impairment, dose reduction is necessary 3:
Topical Application
- For topical application in gauze soaks: 500 mg in 5 mL (100 mg/mL) 5
Important Considerations
Contraindications
- Subarachnoid hemorrhage 3
- Active intravascular clotting 3
- Hypersensitivity to tranexamic acid 3
- Recent thrombosis, atrial fibrillation, or known thrombophilia are relative contraindications 4
Administration Precautions
- Administer IV doses slowly (no more than 1 mL/minute) to avoid hypotension 3
- Ensure IV administration only - serious adverse reactions including seizures and cardiac arrhythmias have occurred with inadvertent intrathecal administration 3
- TXA should NOT be mixed with solutions containing penicillin or blood 3
Monitoring
- Monitor for thromboembolic events, especially when used with pro-thrombotic medications 3
- For adolescents with renal impairment, dose adjustment and monitoring of renal function is necessary 4
Alternative Approaches When First-Line Therapy Unavailable
- For short-term prophylaxis in hereditary angioedema: tranexamic acid may be considered, though efficacy is questionable 1
- For children with hereditary angioedema where first-line agents are unavailable: tranexamic acid at maximum dose of 15-25 mg/kg two to three times daily 1
Research Considerations
- Recent pharmacokinetic research suggests that a dosing regimen of 10-30 mg/kg loading dose followed by 5-10 mg/kg/h maintenance infusion may be optimal for pediatric trauma and surgery 6
- For intramuscular administration in emergency settings where IV access is difficult, 30 mg/kg appears to provide serum concentrations comparable to IV administration 7