Pause (Tranexamic Acid)
Also sold as: Pause, Trenaxa, Texid, Tranostat
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Tablet 500mg +3
Indications
- Heavy menstrual bleeding (menorrhagia)
- Post-partum hemorrhage (per WOMAN trial)
- Trauma hemorrhage (CRASH-2: within 3h)
- Surgical bleeding (cardiac, dental, ENT)
- Hereditary angioedema prophylaxis
- Epistaxis
Adult Dosing
Menorrhagia
1g PO TDS during heavy bleeding days (max 4g/day)
Days 1-4 of cycle
PPH
1g IV slow (over 10 min); repeat after 30 min if bleeding continues
Trauma (within 3h of injury)
1g IV bolus, then 1g IV over 8 hours
Dental procedures (anticoagulants)
Mouthwash or 1g PO 2 hours pre-op
Pediatric Dosing
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 50 | No adjustment |
| CrCl 10-50 | Reduce to 50% dose |
| CrCl < 10 | 25% dose or avoid |
Pregnancy & Lactation
Pregnancy: Category B
Used in PPH; safe
Lactation: Safe
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Combined oral contraceptives (estrogen) | Increased thromboembolism risk | Major |
| Factor IX complex, anti-inhibitor coagulants | Increased thrombosis | Major |
| Tretinoin (acute promyelocytic leukemia) | Increased thrombosis | Major |
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Side Effects
Common
- Nausea
- Diarrhea
- Headache
Serious / Discontinue If
- Thromboembolism (rare in absence of risk factors)
- Vision changes (with high IV doses)
- Seizures (esp in cardiac surgery, high doses)
- Allergic reactions
Contraindications
- Active thromboembolic disease
- History of DVT/PE
- Subarachnoid hemorrhage (worsens vasospasm)
- Severe renal impairment (relative)
- Hypersensitivity
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Pause 500 | Glenmark | 10 tab ₹85 |
| Trenaxa MF 500 | Mankind | 10 tab ₹75 |
| Texid 500 | Cipla | 10 tab ₹95 |
Monitoring Required
- Symptoms of thromboembolism (calf pain, dyspnea)
Patient Counseling Points
- Take only during bleeding days (menorrhagia)
- Stop if leg swelling, calf pain, or breathlessness
- Do not use if you have history of clots
- Effective within 1-2 cycles for heavy periods
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References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- Specialty society guidelines (RSSDI/CSI/IAP)