Aminocaproic acid
Administration
- Type: Antifibrinolytic
- Dosage Forms: tablet (500 mg, 1000 mg), oral solution (250 mg/mL), injection (250 mg/mL)
- Routes of Administration: Oral, IV
- Common Trade Names: Amicar
Adult Dosing
Acute bleeding (general)
- Loading: 4-5 g IV or PO over first hour
- Maintenance: 1-1.25 g/hr IV infusion OR 1-1.25 g PO q1h
- Maximum: 30 g/day
- Continue until bleeding controlled (typically 8-72 hours)
Traumatic hyphema
- 50 mg/kg PO q4h (max 30 g/day) for 5 days
Oral bleeding (post-dental extraction in coagulopathic patients)
- Topical: swish and spit with oral solution
- Systemic: 4-5 g PO loading, then 1 g q4-6h
Pediatric Dosing
- Loading: 100-200 mg/kg IV or PO (max 5 g)
- Maintenance: 100 mg/kg/dose q6h (max 30 g/day)
Special Populations
Pregnancy Rating
- C
Lactation risk
- Unknown; use caution
Renal Dosing
- Adult: Reduce dose in renal impairment (drug is renally excreted); contraindicated in upper urinary tract bleeding
- Pediatric: Reduce dose proportionally
Hepatic Dosing
- Adult: No specific adjustment; use with caution
- Pediatric: No specific adjustment
Contraindications
- Allergy to class/drug
- Active intravascular clotting (DIC) — unless concurrent heparin is used
- Upper urinary tract bleeding (risk of ureteral obstruction from clot)
- History of thromboembolism without concurrent anticoagulation
Adverse Reactions
Serious
- Thrombosis (DVT, PE, arterial thrombosis)
- Rhabdomyolysis (with prolonged use)
- Hyperkalemia
- Seizures (with rapid IV infusion)
Common
- Nausea, vomiting, diarrhea
- Dizziness
- Hypotension (with rapid IV administration)
- Nasal congestion
- Myalgia
Pharmacology
- Half-life: 2 hours
- Metabolism: Minimal hepatic metabolism
- Excretion: Renal (65% excreted unchanged)
Mechanism of Action
- Synthetic lysine analog that competitively inhibits plasminogen activation, thereby inhibiting fibrinolysis and stabilizing clot formation
Comments
- Less commonly used than tranexamic acid (TXA) in the ED setting
- TXA is generally preferred due to better evidence base and more favorable dosing
- Unlike TXA, available as an oral solution (useful for swish-and-spit for oral bleeding)
- Must infuse IV slowly (max 250 mL/h) to avoid hypotension and arrhythmias
- Contraindicated in upper GU tract bleeding — clots can obstruct ureters
- Monitor for signs of thrombosis, especially in patients with underlying hypercoagulability
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.