aminocaproic acid

Action

Interferes with plasminogen activator substances and blocks action of fibrinolysin (plasmin)

Availability

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.

Off-label uses

• Dental extractions

• Hemorrhage

Contraindications

• Hypersensitivity to drug

• Disseminated intravascular coagulation

• Neonates (injectable form)

Precautions

Use cautiously in:

• heart, hepatic, or renal failure

• upper urinary tract bleeding.

Administration

• 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

Adverse reactions

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

Interactions

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

Patient monitoring

• Monitor vital signs, fluid intake and output, and ECG.

See Assess for signs and symptoms of thrombophlebitis and pulmonary embolism.

See 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.

Patient teaching

• Tell patient that drug may significantly affect many body systems. Assure him that he'll be monitored closely.

See 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.