What is the dosing for children's aminocaproic acid (EACA) liquid 0.25g/ml?

Pediatric Aminocaproic Acid (EACA) Liquid Dosing

For children requiring aminocaproic acid liquid (0.25 g/mL), the standard prophylactic dose is 0.05 g/kg twice daily (BID), with a maximum of 0.1 g/kg twice daily, which translates to 0.2 mL/kg BID to 0.4 mL/kg BID of the 0.25 g/mL liquid formulation. 1

Standard Dosing Regimens

For Hereditary Angioedema Prophylaxis

• Initial dose: 0.05 g/kg twice daily (0.2 mL/kg BID of 0.25 g/mL solution) 1
• Dose range: 0.025 g/kg BID to 0.1 g/kg BID (0.1 mL/kg BID to 0.4 mL/kg BID of 0.25 g/mL solution) 1
• Maximum daily dose: 0.2 g/kg/day total 1

For Cardiac Surgery (Tetralogy of Fallot Repair)

Two effective regimens have been studied:

Regimen 1 (More effective):

• 75 mg/kg after induction
• Continuous infusion of 75 mg/kg/hour until chest closure
• Additional 75 mg/kg upon initiation of cardiopulmonary bypass 2

Regimen 2 (Alternative):

• 100 mg/kg after induction
• 100 mg/kg upon initiation of cardiopulmonary bypass
• 100 mg/kg after protamine 2

For Intractable Hematuria

• Dose: 100 mg/kg orally every 6 hours (0.4 mL/kg every 6 hours of 0.25 g/mL solution) 3
• This regimen uniformly led to cessation of hematuria in pediatric patients with hematological disorders 3

For Craniosynostosis Surgery

• Loading dose: 100 mg/kg 4
• Maintenance infusion: 40 mg/kg/hour (associated with 14.3 mL/kg decrease in calculated blood loss compared to lower infusion rates) 4

Volume Calculations for 0.25 g/mL Liquid

Since the concentration is 0.25 g/mL (250 mg/mL):

• 0.05 g/kg = 0.2 mL/kg
• 0.1 g/kg = 0.4 mL/kg
• 100 mg/kg = 0.4 mL/kg

Administration Considerations

• Measuring device: Use an appropriate measuring device such as a 3-mL or 5-mL oral syringe for accurate measurement in infants and young children 5, 6
• Frequency: Typically administered 2-3 times daily for prophylaxis 1
• Duration: For hereditary angioedema prophylaxis, treatment is typically long-term 1

Important Safety Considerations

Contraindications and Monitoring

• Thrombosis risk: Monitor for signs of enhanced thrombosis, particularly in patients with underlying hypercoagulable states 1
• Renal function: No dose adjustment typically required for renal impairment, but monitor for accumulation 1
• Common side effects: Nausea, vertigo, diarrhea, postural hypotension, fatigue, muscle cramps with increased muscle enzymes 1

Reversal of Thrombolytic Therapy

• Aminocaproic acid can effectively reverse tissue plasminogen activator (t-PA) effects when needed 1
• Should be readily available when systemic thrombolysis is being administered 1

Common Pitfalls to Avoid

• Underdosing: The 0.025 g/kg BID dose may be insufficient for adequate prophylaxis; start at 0.05 g/kg BID 1
• Inaccurate measurement: Household teaspoons are unreliable; always use calibrated oral syringes 5, 6
• Inadequate monitoring: Watch for muscle pain and elevated creatine kinase, which may indicate myopathy 1
• Use in active thrombosis: Avoid in patients with active intravascular clotting without hematology consultation 1