Introduction

Tranexamic Acid is one of the listed substance in the Scheduled Poison under Poison Act 1952. This medicine is also listed under the First Schedule of the Poison List in the aforementioned act and all preparations are defined under ‘Group B’ (its use requires a doctor’s prescription) unless specifically exempted. The exemption is when the content of Tranexamic Acid found in cosmetic products obtain notification from the National Pharmaceutical Regulatory Agency (NPRA) under Control of Drugs and Cosmetics Regulations 1984.

The Tranexamic Acid inhibits the decomposition of fibrin in the blood; an insoluble protein that form a network of blood clots. When the decomposition of fibrin is inhibited, the duration of blood clotting is extended and consequently bleeding is ceased.

The two main dosage forms of Tranexamic Acid are injections and capsules. Tranexamic Acid powder in the capsule can be dissolved in a certain amount of water to be used as mouthwash.

Tranexamic Acid Use

In general, the use of Tranexamic Acid is to prevent and control excessive bleeding after undergoing a specific procedure or surgery; especially in patients who have high risks of bleeding. These are patients who are suffering from hemophilia; a kind of genetic disease that causes the sufferer to have blood clotting abnormality.

This medicine is also used for women who have large volume and prolonged menstrual flow. In this cases, however, the patients should be referred to and monitored by a gynecologist if symptoms persist.

In addition, those who suffer from prolonged bleeding of the nose, mouth or gums especially after tooth extraction could also benefit from this medicine.

Side Effects

Among the common side effects of Tranexamic Acid are headache, joint pain, muscle pain and cramps, nasal congestion, abdominal pain and feeling lethargic.

Serious side effects that require immediate attention are:

1. Allergy reaction (rash, itchiness, difficulty in breathing, swelling of the face, lips, or tongue)
2. Leg pain
3. Swelling and pain throughout the body
4. Chest Pain
5. Chest tightness and difficulty in breathing
6. Confusion
7. Cough out blood
8. Poor or difficult urination
9. Vision disturbances (impaired colour vision, blurred)
10. Feeling of numbness in the arms or legs
11. Seizures
12. Severe Dizziness
13. Shortness of breath
14. Vomiting and extreme lethargy

Consumers should seek advice from a doctor or pharmacist if they experience common side effects, and seek help from a hospital’s Emergency Department immediately for serious complications.

Contraindication and precautions

Tranexamic Acid cannot be used if the patient has a history of allergic reactions, thromboembolic disease, impaired vision, women who have irregular periods, individuals suffering from brain hemorrhage, blood in the urine or bleeding caused by kidney problems, pregnant mothers, and individuals who use combination of estrogen and progesterone contraceptive pills.

Apart from that, those who have blood clotting problems or situations that increase the risk of blood clots, for example patients who have heart valves or rhythm problems should not use this medication as well.

Additionally, Tranexamic Acid causes increased dizziness if taken with alcohol or other medicines.

Current Issues and Use of Tranexamic Acid without Supervision

In 1979, a researcher discovered that Tranexamic Acid can help reduce and improve a skin condition called Melasma as an accidental observation. Several reports emerged subsequently with similar observation, however there were no extensive controlled trials have been conducted to prove the finding. Melasma is caused by hyperpigmentation resulting in patches of dark-spots on the skin of face area.

Consequently, there are a good number of individuals who take advantage of these reports claiming that Tranexamic Acid is a safe skin bleaching agent.

Reports from the Pharmacy Enforcement Division revealed that there were incidents of transaction of Tranexamic Acid for the purpose of skin whitening by unauthorised or unlicensed individuals. This is illegal and has a huge potential of health hazard to the public. Various preparations and method of use were offered by this irresponsible sellers such as injections, capsules and some even suggested this medicine to be mixed with drinks or fruit juices or mix with plain water to be applied to the face.

Such method is not recommended by the manufacturer given the fact that there were no clinical evidence that demonstrates the act is more effective and could lighten the skin tone in general. Moreover, the price for the product that these sellers offer can go up to 6 times higher than that of the recommended retail price by the manufacturer.

Advice to Consumer

Consumers are urged to seek advise from doctors or pharmacists before purchasing any Tranexamic Acid containing products. It should also be emphasized that the sale and use of this medicine, whether in oral or injectable forms are solely by authorised doctors’ prescriptions and supervision. Do not easily fall for advertisements on the internet and social media promoting Tranexamic Acid for skin lightening purposes. To date, there is no conclusive scientific data showing that the medicine is effective as a safe skin lightening agent.

Consumers should be wise in choosing the source of information to have insights on the use of medications not only for the sake of their own health and protection from harmful products but also for their family and community as a whole.

References

1. British National Formulary 69; March – September 2015
2. http://online1.mimsgateway.com.my/
3. Lexicomp Drug Information Handbook. 24th Edition; 2015-2016
4. Medscape: Drugs & Diseases: Tranexamic Acid
5. Tranexamic Acid: Package Insert Information for the User; Cyclokapron 100mg/ml Solution for Injection. Pfizer Canada Inc
6. www.Webmd.com: Use, Side effects & Interactions of Tranexamic Acid