AMINOCAPROIC ACID

(a-mee-noe-ka-proe'ik)

Amicar
Classifications: coagulator, hemostatic, systemic;
Therapeutic:antihemorrhagic; antifibrinolytic
Pregnancy Category: C

Availability

250 mg/mL injection

500 mg tablets; 250 mg/mL syrup

Action

Synthetic hemostatic with specific antifibrinolysis action. Inhibits plasminogen activator substance, and to a lesser degree plasmin (fibrinolysin), which is concerned with destruction of clots.

Therapeutic Effect

Acts as an inhibitor of fibrinolytic bleeding.

Uses

To control excessive bleeding resulting from systemic hyperfibrinolysis; also used in urinary fibrinolysis associated with severe trauma, anoxia, shock, urologic surgery, and neoplastic diseases of GU tract.

Unlabeled Uses

To prevent hemorrhage in hemophiliacs undergoing dental extraction; as a specific antidote for streptokinase or urokinase toxicity; to prevent recurrence of subarachnoid hemorrhage, especially when surgery is delayed; for management of amegakaryocytic thrombocytopenia; and to prevent or abort hereditary angioedema episodes.

Contraindications

Severe renal impairment; active disseminated intravascular clotting (DIC); upper urinary tract bleeding (hematuria); hemophilia; benzyl alcohol hypersensitivity, especially in neonates; paraben hypersensitivity; pregnancy (category C); lactation.

Cautious Use

Cardiac, renal, or hepatic disease; renal impairment; history of pulmonary embolus or other thrombotic diseases; hypovolemia.

Route & Dosage

Hemostatic
Adult: PO/IV 4–5 g during first hour, then 1–1.25 g qh for 8 h or until bleeding is controlled (max: 30 g/24h)
Child: PO/IV 100 mg/kg or 3 g/m² during first hour, then 33.3 mg²/kg qh (max: 18 g/m²/24 h)

Renal Impairment
Reduce dose to 15–25% of normal dose.

Administration

Oral

Note: May need to give patient as many as 10 tablets or 4 tsp for a 5 g dose during the first hour of treatment (each tablet contains 500 mg, syrup contains 250 mg/mL).

Intravenous

PREPARE: IV Infusion: Dilute parenteral aminocaproic acid before use. Each 4 mL (1 g) is diluted with 50 mL of NS, D5W, or RL.

ADMINISTER: IV Infusion: ?? Physician orders specific IV flow rate.??Usual rate is 5 g or a fraction thereof over first hour (5 g/250 mL).??Give each additional gram over 1 h. Avoid rapid infusion to prevent hypotension, faintness, and bradycardia or other arrhythmias.

INCOMPATIBILITIES Solution/additive: Fructose solution.

Store in tightly closed containers at 15°–30° C (59°–86° F) unless otherwise directed. Avoid freezing.

Adverse Effects (≥1%)

CNS: Dizziness, malaise, headache, seizures. CV: Faintness, orthostatic hypotension; dysrhythmias; thrombophlebitis, thromboses. Special Senses: Tinnitus, nasal congestion. Conjunctival erythema. GI: Nausea, vomiting, cramps, diarrhea, anorexia. Urogenital: Diuresis, dysuria, urinary frequency, oliguria, reddish-brown urine (myoglobinuria), acute renal failure. Prolonged menstruation with cramping. Skin: Rash.

Diagnostic Test Interference

Serum potassium may be elevated (especially in patients with impaired renal function).

Interactions

Drug: estrogens, oral contraceptives may cause hypercoagulation.

Pharmacokinetics

Absorption: Rapidly from GI tract. Peak: 2 h. Distribution: Readily penetrates RBCs and other body cells. Elimination: 80% as unmetabolized drug in 12 h.

Nursing Implications

Assessment & Drug Effects

Check IV site at frequent intervals for extravasation.
Observe for signs of thrombophlebitis. Change site immediately if extravasation or thrombophlebitis occurs (see Appendix F).
Monitor & report S&S of myopathy: muscle weakness, myalgia, diaphoresis, fever, reddish-brown urine (myoglobinuria), oliguria, as well as thrombotic complications: arm or leg pain, tenderness or swelling, Homan's sign, prominence of superficial veins, chest pain, breathlessness, dyspnea. Drug should be discontinued promptly.
Monitor vital signs and urine output.
Lab tests: with prolonged therapy, monitor creatine phosphokinase activity and urinalyses for early detection of myopathy.

Patient & Family Education

Report difficulty urinating or reddish-brown urine.
Report arm or leg pain, chest pain, or difficulty breathing.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(76)