Summary of use during lactation
Amounts of tranexamic acid in breastmilk appear to be low. Recent expert opinion considers that breastfeeding should be permitted in infants whose mothers require treatment with tranexamic acid.[1] Tranexamic acid is used for hereditary angioedema in low-income countries where first-line treatments are not available, but should not be used if C1-INH is available.[2]
Drug levels in milk and infant serum
Maternal Levels. Unpublished data from the manufacturer indicates that the concentration of tranexamic acid in breastmilk is 1% of the peak serum concentration 1 hour after the last dose of a 2-day treatment course.[3] Further details of the study have not been published. A dose-finding study of 30 women who received either 5, 10 or 15 mg/kg of tranexamic acid at the time of cord clamping after cesarean delivery collected convenience samples of milk at unspecified times when mothers were nursing their neonates. Tranexamic acid levels in milk were measured in 7 patients. Three samples had no detectable tranexamic acid (<0.04 mg/L). The other samples contained tranexamic acid concentrations ranging from 0.06 to 0.47 mg/L.[4] Infant Levels. Relevant published information was not found as of the revision date.
Effects in breastfed infants
Twenty-one mothers who took tranexamic acid during breastfeeding were compared to 42 mothers who took amoxicillin during breastfeeding. In the study population, the tranexamic acid dosage ranged between 1.5 and 4 grams daily at an average of 4.2 months of age and 81% exclusively breastfed their infants. The average time of follow-up of the infants of study mothers was 35.7 months of age. No statistically significant difference were found between the study and control groups in possible drug side effects, neurological development or general health.[5] A randomized, double-blind, multicenter study compared the use of a 1 gram dose of intravenous tranexamic acid (n = 10,051) to placebo (n = 10,009) in women with postpartum hemorrhage. The dose could be repeated in 24 hours if bleeding recurred. Among babies who were breastfed, no difference in infant deaths were seen between the two groups, nor were any thromboembolic events reported. The numbers of breastfed infants in each group were not reported.[6]
Effects on lactation and breastmilk
Relevant published information was not found as of the revision date.
Source: Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, NCBI Bookshelf. Check LactMed for the most recent revision.
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