AMICAR (aminocaproic acid)

There are 1 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction

Drug Names

Antifibrinolytics/Factor IX; Anti-Inhibitor Coagulant Conc SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Concurrent use may result in additive or synergistic effects on the coagulation pathways.(1-3) CLINICAL EFFECTS: Concurrent use may result in thrombosis.(1-3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of aminocaproic acid states that aminocaproic acid should not be administered concomitantly with Factor IX Complex concentrates or with Anti-inhibitor Coagulant concentrates.(1) The manufacturer of tranexamic acid states that tranexamic acid should not be administered concomitantly with Factor IX Complex concentrates or with Anti-inhibitor Coagulant concentrates.(2,3) Concurrent use may be warranted in select patients with hemophilia A or hemophilia B. Monitor patients closely for signs of thrombosis, disseminated intravascular coagulation, and hypercoagulability if concurrent use is deemed necessary.(4-6) DISCUSSION: Because of the increased risk of thrombosis, the manufacturer of aminocaproic acid states that aminocaproic acid should not be administered concomitantly with Factor IX Complex concentrates or with Anti-inhibitor Coagulant concentrates.(1) Because of the increased risk of thrombosis, the manufacturer of tranexamic acid states that tranexamic acid should not be administered concomitantly with Factor IX Complex concentrates or with Anti-inhibitor Coagulant concentrates.(2,3) In a study, eight hemophilia B patients undergoing dental extraction procedures received combination therapy with aminocaproic acid or tranexamic acid and monoclonal antibody purified factor IX for bleeding prophylaxis. All patients achieved hemostasis without clinical evidence of thrombosis as well as no changes were seen in hemoglobin, hematocrit, or in markers of hemostatic system activation.(4) In a study, seven hemophilia A patients with inhibitors and one with acquired hemophilia patient received activated prothrombin complex concentrate (APCC) and tranexamic acid for management of bleeding episodes and prevention of hemorrhage during surgery. Hemostatic outcomes were rated excellent or good in 10 out of 11 (91%) treatment episodes. No episodes of thrombosis or disseminated intravascular coagulation occurred during treatment.(5) A study in six hemophilia A patients and five healthy volunteers evaluated the use of tranexamic acid as an adjunct to APCC to control bleeding. Patients who received tranexamic acid had a significant increase in maximum clot firmness compared to healthy controls. No clinical or laboratory signs of thromboembolic events, disseminated intravascular coagulation, or hypercoagulability were observed.(6)

ALPHANINE SD, ALPROLIX, BENEFIX, FEIBA, IDELVION, IXINITY, KCENTRA, PROFILNINE, REBINYN, RIXUBIS

Drug contraindication overview.

*Active intravascular clotting process. *When it is not clear whether hemorrhage is secondary to primary fibrinolysis or disseminated intravascular coagulation (DIC), the distinction must be made before aminocaproic acid is administered. Do not use without concomitant heparin therapy in patients with evidence of DIC.

Adverse reaction overview.

Adverse effects have included nausea, vomiting, cramping, abdominal pain, diarrhea, dizziness, malaise, dyspnea, nasal congestion, headache, edema, and pruritus.

Safety and efficacy of aminocaproic acid in pediatric patients have not been established. Aminocaproic acid injection contains benzyl alcohol as a preservative. Administration of injections preserved with benzyl alcohol has been associated with toxicity in neonates.

Toxicity appears to have resulted from administration of large amounts (i.e., 100-400 mg/kg daily) of benzyl alcohol in these neonates. Each mL of aminocaproic acid injection in multiple-dose vials contains 9 mg of benzyl alcohol. Although use of drugs preserved with benzyl alcohol should be avoided in neonates whenever possible, the American Academy of Pediatrics (AAP) states that the presence of small amounts of the preservative in a commercially available injection should not proscribe its use when indicated in neonates.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None