Tranexamic acid (TXA) is a synthetic derivative of the amino acid lysine used to prevent excessive blood loss. It works by inhibiting the breakdown of fibrin clots, stabilizing them to promote hemostasis. However, due to its impact on the clotting system, TXA should not be used with certain medications or in specific medical conditions as it can lead to severe risks. Always consult a healthcare professional before starting or stopping any medication.
Combined Hormonal Contraceptives
Combined hormonal contraceptives, including pills, patches, and vaginal rings containing estrogen and progestin, are a significant interaction risk with tranexamic acid.
- Risk: Both TXA and these contraceptives increase the risk of blood clots (thromboembolic events) independently. Combining them significantly elevates this risk.
- Who is at risk: The risk is higher for those who are obese, smoke, or are over 35.
- Recommendation: Concomitant use is generally contraindicated.
For information regarding other drug interactions and contraindications, including coagulation factor concentrates, thrombolytic agents, all-trans retinoic acid (tretinoin), active intravascular clotting, subarachnoid hemorrhage, renal impairment, and history of seizure disorder, please refer to the {Link: Drugs.com https://www.drugs.com/pro/tranexamic-acid-tablet.html}.
Comparison of Major Tranexamic Acid Interactions
| Drug/Drug Class | Interaction Type | Primary Risk | Recommendation |
|---|---|---|---|
| Combined Hormonal Contraceptives | Additive procoagulant effect | Significantly increased risk of blood clots (thrombosis) | Avoid concomitant use; contraindicated |
| Factor IX Complex Concentrates | Additive procoagulant effect | Increased risk of thrombosis | Not recommended; avoid use |
| Thrombolytic Agents (e.g., Alteplase) | Antagonistic effect | Reduced efficacy of both drugs | Discontinue TXA if patient requires thrombolytics |
| All-Trans Retinoic Acid (Oral Tretinoin) | Exacerbated procoagulant effect | Possible bleeding issues or heightened clotting | Not recommended in acute promyelocytic leukemia |
Conclusion
Understanding what cannot mix with tranexamic acid is vital for safety. Key interactions involve other medications affecting clotting, such as combined hormonal contraceptives, concentrated clotting factors, and thrombolytics. Additionally, avoid TXA in patients with active intravascular clotting, a history of thromboembolic disease, or subarachnoid hemorrhage. Patients with severe renal impairment also require caution. Always inform healthcare providers and pharmacists of your complete medical history to identify potential risks.
For more detailed information, consult the {Link: FDA https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/019281s047lbl.pdf} for tranexamic acid.
