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ISSUE 4 AUGUST
Letters to the Editor

Preparing tranexamic acid 4.8% mouthwash

  • Fotios Ambados

The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

 

Letter to the editor

Editor, – The beneficial haemostatic effect of tranexamic acid 4.8% mouthwash has been demonstrated in oral anticoagulant treated patients undergoing minor oral surgery.1,2However there is no proprietary product readily available to dental practitioners in private practice (Aust Prescr 2002;25:105-6). A practical solution to this problem is the use of Cyclokapron tablets dispersed in water. A crude mouthwash can be prepared by placing a tranexamic acid 500 mg tablet into 10-15 mL of water in a metric measure. The tablet will disperse in approximately 3-5 minutes on standing and quicker with intermittent swirling. Tranexamic acid is readily soluble in water3, however inactive tablet excipients will still be present after adequate mixing. The resulting slurry has little or no taste. Patients should be instructed to swirl the total preparation including the undissolved residue around the mouth for two minutes and then to expel. This is repeated four times a day for up to seven days.1,2Although this method has not been formally validated, sufficient tranexamic acid should be present in the saliva to reduce fibrinolysis.4

Unfortunately the Pharmaceutical Benefits Scheme does not subsidise tranexamic acid 500 mg tablets when prescribed by a dental practitioner. However, they are available as a private dental prescription at a cost of around $31 for a broken pack quantity of 20 tablets. For dental practitioners with no access or assistance from a public teaching hospital this approach partly addresses the issue of having ready access to the mouthwash, although it will not be suitable for all patients.

Fotios Ambados

Specialist Pharmacist, Production Services

The Queen Elizabeth Hospital

Woodville South, SA

 

References

  1. Sindet-Pedersen S, Ramstrom G, Bernvil S, Blomback M. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N Engl J Med 1989;320:840-3.
  2. Ramstrom G, Sindet-Pedersen S, Hall G, Blomback M, Alander U. Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg 1993;51:1211-6.
  3. Windholz M, editor. The Merck index. 10th ed. Rahway, NJ: Merck & Co.; 1983. p. 1368-9.
  4. Sindet-Pedersen S. Distribution of tranexamic acid to plasma and saliva after oral administration and mouth rinsing: a pharmacokinetic study. J Clin Pharmacol 1987;27:1005-8.

Fotios Ambados

Specialist Pharmacist, Production Services The Queen Elizabeth Hospital Woodville South, SA