What is the maximum dose of Trenexa?

Maximum Dose of Tranexamic Acid (Trenexa)

For menorrhagia, the maximum dose is 4 grams per day (1 gram four times daily) for 4-5 days per menstrual cycle, while for acute trauma hemorrhage, the maximum total dose is 2 grams (1 gram loading dose followed by 1 gram infusion over 8 hours). 1, 2

Dosing by Clinical Indication

Menorrhagia (Heavy Menstrual Bleeding)

• Standard dosing: 1 gram (two 500 mg tablets) three times daily for up to 5 days during menstruation 1
• Maximum daily dose: 4 grams per day, typically given as 1 gram four times daily for 4 days 1, 3, 4
• Clinical trials have used doses ranging from 2-4.5 grams per day for 4-7 days with demonstrated efficacy 4

Acute Trauma Hemorrhage

• Loading dose: 1 gram IV over 10 minutes 2
• Maintenance infusion: 1 gram IV over 8 hours 2
• Maximum total dose: 2 grams per episode 2
• Critical timing: Must be initiated within 3 hours of injury for mortality benefit; treatment beyond 3 hours may be harmful 2

Cardiac Surgery

• Common regimen: 10 mg/kg loading dose followed by 1 mg/kg/hour infusion 3, 5
• Studies have used various protocols, but the total dose typically does not exceed 2-3 grams over the perioperative period 5

Upper Gastrointestinal Bleeding

• High-dose extended regimen (NOT recommended): 1 gram loading dose followed by 3 grams over 24 hours showed no mortality benefit and increased thrombotic complications 6
• Low-dose regimens: Various protocols using lower doses or enteral administration may be more appropriate, though optimal dosing remains uncertain 6

Important Safety Considerations

Seizure Risk

• Tranexamic acid increases seizure risk, particularly at higher doses 5
• In cardiac surgery, seizures occurred in 0.7% of patients receiving tranexamic acid versus 0.1% with placebo 5

Thrombotic Complications

• Extended-use high-dose IV tranexamic acid (loading dose plus 3 grams over 24 hours) significantly increases deep venous thrombosis (relative risk 2.01), pulmonary embolism (relative risk 1.78), and seizures (relative risk 1.73) 6
• Standard dosing for trauma (2 grams total) does not appear to increase thrombotic risk when given within 3 hours of injury 2

Renal Impairment

• Dose reduction is necessary in renal insufficiency, though specific guidelines vary by indication 1

Clinical Pitfalls to Avoid

Do not exceed 4 grams per day for menorrhagia - higher doses have not been studied and may increase adverse effects 1, 4

Do not use extended high-dose protocols (>2 grams) for gastrointestinal bleeding - this increases thrombotic complications without improving outcomes 6

Do not administer tranexamic acid beyond 3 hours after trauma - late administration may increase mortality rather than reduce it 2

Do not use in patients with active thromboembolic disease - tranexamic acid is contraindicated in these patients 3, 6