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Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketRecently, there has been a lot of buzz about the use of topical tranexamic acid for epistaxis or oral bleeds on multiple social media platforms. What is the literature regarding the use of topical tranexamic acid for epistaxis or oral bleeds? While there is little evidence available directly regarding the use of topical tranexamic acid (TXA) for epistaxis or oral bleeds in the emergency department (ED), the use of topical TXA has been used for epistaxis, hyphema, and dental extractions in a variety of settings. There are several studies from older literature showing the safety of topical TXA use in patients currently on warfarin.
In a Cochrane review of the topical use of TXA in intra-cardiac surgery, orthopedic surgery, epistaxis, and dental extractions, there were no adverse events reported regarding myocardial infarction, pulmonary embolism, stroke, or deep vein thrombosis.
The studies cited above used a variety of methods for extemporaneous compounding of TXA ranging from 0.05% to 10% solutions. Feel free to ask questions here on the blog for others to see, so that maybe your question can help others as well. Im a compounding pharmacist for Spain and I am searching for information about how to compound the tranexamic acid as a intranasal gel to treat the epistaxis.
Canker Sores Symptoms, Causes, Treatment - What kind of topical medications (gels or ointments) are available for canker sores? Topical methods of delivery also are widely used because they allow the absorption of medicine directly through the skin, and may help avoid potential side effects such as stomach upset or drowsiness. Note: While we endeavour to keep our records up-to-date one should not rely on these details being accurate without first consulting a professional.
Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2% contains a local anesthetic agent and is administered topically. Chromatographic Determination of Aminoacridine Hydrochloride, Lidocaine Hydrochloride and Lidocaine Toxic Impurity in Oral Gel. Two sensitive and selective analytical methods were developed for simultaneous determination of aminoacridine hydrochloride and lidocaine hydrochloride in bulk powder and pharmaceutical formulation. The molecular structure and vibrational, (1)H and (13)C NMR spectra of lidocaine hydrochloride monohydrate. Pharmacokinetics of Lidocaine Hydrochloride Metabolized by CYP3A4 in Chinese Han Volunteers Living at Low Altitude and in Native Han and Tibetan Chinese Volunteers Living at High Altitude.
Characterisation and in vitro stability of low-dose, lidocaine-loaded poly(vinyl alcohol)-tetrahydroxyborate hydrogels.
Within medicine, nutrition (the study of food and the effect of its components on the body) has many different roles.
Everyone seems so happy that it works so well, but we thought we would look through the literature and see what the evidence for use of topical tranexamic acid (TXA) is and how best to compound it for these clinical dilemma.
Its use has been studied in patients both on and off oral anticoagulants and with or without bleeding disorders such as hemophilia.
The intravenous (IV) solution is FDA approved in patients with hemophilia for short-term use (two to eight days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction while the oral (PO) formulation is FDA approval for the treatment of cyclic heavy menstrual bleeding.
It was reported to incidentally reduce the need for blood transfusions by 45%.(23881695) Based on these results and results of studies included in this analysis including a wide variety of patients, topical TXA may be considered safe for use. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland.

The Pharmacy is conveniently located in Williamson County (Brentwood, Cool Springs & Franklin). It can be extrapolated from the studies that topical TXA is effective in stopping or controlling bleeds, and has been shown to be safe for use in these cases. Despite the narrow indications for which TXA is approved in the United States, it has been studied in a wide variety of conditions in which systemic or local hyperfibrinolysis is involved including cardiac surgery, orthopedic surgery, spinal surgery, post-partum hemorrhage, gastrointestinal bleeding, trauma, epistaxis, hyphema, and dental extractions.(22397329) The formulation of TXA has not been standardized across the various studies with a range of IV, PO, and topical solutions being used. There was also a higher rate of rebleeding in the first 24 hours and within 1 week in the group treated with anterior nasal packing as compared to those treated with TXA.
If the 500 mg tablets are available, one tablet can be placed into 20 mL of water, and stirred until the tablets are completely disintegrated to form a fine particular suspension.
Rezaie, MD is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983.
In addition each mL contains the following inactive ingredients: Carboxymethylcellulose sodium, methylparaben, natural orange flavor, propylparaben, purified water, saccharin sodium. Topical TXA is an attractive option as it would inhibit local fibrinolysis at the site of bleeding with minimal systemic absorption.(23881695) This review will focus on the topical use of TXA in localized hyperfibrinolysis such as epistaxis, dental procedures, and hyphema.
It is suggested that a maximum expiration date of five days should be employed if refrigerated, and the solution should be protected from light.3 In the place of a 500 mg tablet, it seems that use of a 650 mg tablet dissolved in 20 mL could be safely used as well. In both cases, the cohort receiving topical TXA was significantly older, and had a significantly lower intraocular pressure at baseline.
Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident. These changes may be attributable to a direct depressant effect of the local anesthetic agent on various components of the cardiovascular system. Treatment with topical TXA was well tolerated, and the authors concluded that topical TXA may be an option for treatment of hyphema grades 1-3, although the study design and small sample size limited them from making any decisive conclusions.
He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey. The net effect is normally a modest hypotension when the recommended dosages are not exceeded.Lidocaine is absorbed following topical administration to mucous membranes, its rate and extent of absorption being dependent upon concentration and total dose administered, the specific site of application, and duration of exposure.
In general, the rate of absorption of local anesthetic agents following topical application occurs most rapidly after intratracheal administration. Lidocaine is also well-absorbed from the gastrointestinal tract, but little intact drug appears in the circulation because of biotransformation in the liver.The plasma binding of lidocaine is dependent on drug concentration, and the fraction bound decreases with increasing concentration. At concentrations of 1 to 4 mcg of free base per mL, 60 to 80 percent of lidocaine is protein bound. Biotransformation includes oxidative N-dealkylation, ring hydroxylation, cleavage of the amide linkage, and conjugation. N-dealkylation, a major pathway of biotransformation, yields the metabolites monoethylglycinexylidide and glycinexylidide. Approximately 90% of lidocaine administered is excreted in the form of various metabolites, and less than 10% is excreted unchanged.

Because of the rapid rate at which lidocaine is metabolized, any condition that affects liver function may alter lidocaine kinetics. Renal dysfunction does not affect lidocaine kinetics but may increase the accumulation of metabolites.Factors such as acidosis and the use of CNS stimulants and depressants affect the CNS levels of lidocaine required to produce overt systemic effects.
Objective adverse manifestations become increasingly apparent with increasing venous plasma levels above 6.0 mcg free base per mL. The lowest dosage that results in effective anesthesia should be used to avoid high plasma levels and serious adverse effects. Debilitated, elderly patients, acutely ill patients, and children should be given reduced doses commensurate with their age, weight and physical condition. Lidocaine should also be used with caution in patients with severe shock or heart block.Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2% should be used with caution in persons with known drug sensitivities. For this reason, food should not be ingested for 60 minutes following use of local anesthetic preparations in the mouth or throat area. This is particularly important in children because of their frequency of eating.Numbness of the tongue or buccal mucosa may increase the danger of biting trauma. Reproduction studies have been performed in rats at doses up to 6.6 times the human dose and have revealed no evidence of harm to the fetus caused by lidocaine. Because animal reproduction studies are not always predictive of human response, this drug should be used in pregnancy only if clearly needed.It is not known whether this drug is excreted in human milk.
Because many drugs are excreted in human milk, caution should be exercised when lidocaine is administered to nursing women.Dosages in children should be reduced, commensurate with age, body weight and physical condition.
These adverse experiences are, in general, dose-related and may result from high plasma levels caused by excessive dosage or rapid absorption, or may result from a hypersensitivity, idiosyncrasy, or diminished tolerance on the part of the patient. Allergic reactions as a result of sensitivity to lidocaine are extremely rare and, if they occur, should be managed by conventional means.
In situations where trained personnel are readily available, ventilation should be maintained and oxygen should be delivered by a delivery system capable of permitting immediate positive airway pressure by mask. Immediately after the institution of these ventilatory measures, the adequacy of the circulation should be evaluated, keeping in mind that drugs used to treat convulsions sometimes depress the circulation when administered intravenously. Should convulsions persist despite adequate respiratory support, and if the status of the circulation permits, small increments of an ultra-short acting barbiturate (such as thiopental or thiamylal) or a benzodiazepine (such as diazepam) may be administered intravenously. The clinician should be familiar, prior to use of local anesthetics, with these anticonvulsant drugs. This dose should not be administered at intervals of less than three hours, and not more than eight doses should be given in a 24-hour period.The dosage should be adjusted commensurate with the patient's age, weight and physical condition.
For children over 3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the child's weight or age.

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