"Jan. 9, 2013 -- Heavy menstrual bleeding is a rarely discussed but remarkably common condition that affects about 1 in 4 women.
For many, monthly periods are much more than a minor annoyance. They stop life in its tracks for days each"...
Clinical Trial Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to the rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
The safety of LYSTEDA (tranexamic acid tablets) in the treatment of heavy menstrual bleeding (HMB) was studied in two randomized, double-blind, placebo-controlled studies [see Clinical Studies]. One study compared the effects of two doses of LYSTEDA (tranexamic acid tablets) (1950 mg and 3900 mg given daily for up to 5 days during each menstrual period) versus placebo over a 3-cycle treatment duration. A total of 304 women were randomized to this study, with 115 receiving at least one dose of 3900 mg/day of LYSTEDA (tranexamic acid tablets) . A second study compared the effects of LYSTEDA (tranexamic acid tablets) (3900 mg/day) versus placebo over a 6-cycle treatment duration. A total of 196 women were randomized to this study, with 117 receiving at least one dose of LYSTEDA (tranexamic acid tablets) . In both studies, subjects were generally healthy women who had menstrual blood loss of ≥ 80 mL.
In these studies, subjects were 18 to 49 years of age with a mean age of approximately 40 years, had cyclic menses every 21-35 days, and a BMI of approximately 32 kg/m². On average, subjects had a history of HMB for approximately 10 years and 40% had fibroids as determined by transvaginal ultrasound. Approximately 70% were Caucasian, 25% were Black, and 5% were Asian, Native American, Pacific Islander, or Other. Seven percent (7%) of all subjects were of Hispanic origin. Women using hormonal contraception were excluded from the trials.
The rates of discontinuation due to adverse events during the two clinical trials were comparable between LYSTEDA (tranexamic acid tablets) and placebo. In the 3-cycle study, the rate in the 3900 mg LYSTEDA (tranexamic acid tablets) dose group was 0.8% as compared to 1.4% in the placebo group. In the 6-cycle study, the rate in the LYSTEDA (tranexamic acid tablets) group was 2.4% as compared to 4.1% in the placebo group. Across the studies, the combined exposure to 3900 mg/day LYSTEDA (tranexamic acid tablets) was 947 cycles and the average duration of use was 3.4 days per cycle.
A list of adverse events occurring in ≥ 5% of subjects and more frequently in LYSTEDA (tranexamic acid tablets) treated subjects receiving 3900 mg/day compared to placebo is provided in Table 2.
Table 2: Adverse Events Reported by ≥ 5% of Subjects Treated
with LYSTEDA (tranexamic acid tablets) and More Frequently in LYSTEDA (tranexamic acid tablets) -treated Subjects
|LYSTEDA 3900 mg/day n (%)
|Placebo n (%)
|Total Number of Adverse Events||1500||923|
|Number of Subjects with at Least One Adverse Event||208 (89.7%)||122 (87.8%)|
|HEADACHEa||117 (50.4%)||65 (46.8%)|
|NASAL & SINUS SYMPTOMSb||59 (25.4%)||24 (17.3%)|
|BACK PAIN||48 (20.7%)||21 (15.1%)|
|ABDOMINAL PAINc||46 (19.8%)||25 (18.0%)|
|MUSCULOSKELETAL PAINd||26 (11.2%)||4 (2.9%)|
|ARTHRALGIAe||16 (6.9%)||7 (5.0%)|
|MUSCLE CRAMPS & SPASMS||15 (6.5%)||8 (5.8%)|
|MIGRAINE||14 (6.0%)||8 (5.8%)|
|ANEMIA||13 (5.6%)||5 (3.6%)|
|FATIGUE||12 (5.2%)||6 (4.3%)|
|a Includes headache and tension
b Nasal and sinus symptoms include nasal, respiratory tract and sinus congestion, sinusitis, acute sinusitis, sinus headache, allergic sinusitis and sinus pain, and multiple allergies and seasonal allergies
c Abdominal pain includes abdominal tenderness and discomfort
d Musculoskeletal pain includes musculoskeletal discomfort and myalgia
e Arthralgia includes joint stiffness and swelling
Long-term safety of LYSTEDA (tranexamic acid tablets) was studied in two open-label studies. In one study, subjects with physician-diagnosed heavy menstrual bleeding (not using the alkaline hematin methodology) were treated with 3900 mg/day for up to 5 days during each menstrual period for up to 27 menstrual cycles. A total of 781 subjects were enrolled and 239 completed the study through 27 menstrual cycles. A total of 12.4% of the subjects withdrew due to adverse events. Women using hormonal contraception were excluded from the study. The total exposure in this study to 3900 mg/day LYSTEDA (tranexamic acid tablets) was 10,213 cycles. The average duration of LYSTEDA (tranexamic acid tablets) use was 2.9 days per cycle.
A long-term open-label extension study of subjects from the two short-term efficacy studies was also conducted in which subjects were treated with 3900 mg/day for up to 5 days during each menstrual period for up to 9 menstrual cycles. A total of 288 subjects were enrolled and 196 subjects completed the study through 9 menstrual cycles. A total of 2.1% of the subjects withdrew due to adverse events. The total exposure to 3900 mg/day LYSTEDA (tranexamic acid tablets) in this study was 1,956 cycles. The average duration of LYSTEDA (tranexamic acid tablets) use was 3.5 days per cycle.
The types and severity of adverse events in these two long-term open-label trials were similar to those observed in the double-blind, placebo-controlled studies although the percentage of subjects reporting them was greater in the 27-month study, most likely because of the longer study duration.
A case of severe allergic reaction to LYSTEDA (tranexamic acid tablets) was reported in the extension trial, involving a subject on her fourth cycle of treatment, who experienced dyspnea, tightening of her throat, and facial flushing that required emergency medical treatment.
The following adverse reactions have been identified from postmarketing experience with tranexamic acid. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Based on US and worldwide postmarketing reports, the following have been reported in patients receiving tranexamic acid for various indications:
- Nausea, vomiting, and diarrhea
- Allergic skin reactions
- Anaphylactic shock and anaphylactoid reactions
- Thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism, cerebral thrombosis, acute renal cortical necrosis, and central retinal artery and vein obstruction)
- Impaired color vision and other visual disturbances
Read the Lysteda (tranexamic acid tablets) Side Effects Center for a complete guide to possible side effects »
No drug-drug interaction studies were conducted with LYSTEDA (tranexamic acid tablets) .
Because LYSTEDA (tranexamic acid tablets) is antifibrinolytic, concomitant use of hormonal contraception and LYSTEDA (tranexamic acid tablets) may further exacerbate the increased thrombotic risk associated with combination hormonal contraceptives. Women using hormonal contraception should use LYSTEDA (tranexamic acid tablets) only if there is a strong medical need and the benefit of treatment will outweigh the potential increased risk of a thrombotic event [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].
Tissue Plasminogen Activators
Concomitant therapy with tissue plasminogen activators may decrease the efficacy of both LYSTEDA (tranexamic acid tablets) and tissue plasminogen activators. Therefore, exercise caution if a woman taking LYSTEDA (tranexamic acid tablets) therapy requires tissue plasminogen activators.
Factor IX Complex Concentrates or Anti-Inhibitor Coagulant Concentrates
LYSTEDA (tranexamic acid tablets) is not recommended for women taking either Factor IX complex concentrates or anti-inhibitor coagulant concentrates because the risk of thrombosis may be increased [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].
All-Trans Retinoic Acid (Oral Tretinoin)
Exercise caution when prescribing LYSTEDA (tranexamic acid tablets) to women with acute promyelocytic leukemia taking all-trans retinoic acid for remission induction because of possible exacerbation of the procoagulant effect of all-trans retinoic acid [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].
Last reviewed on RxList: 5/19/2011
This monograph has been modified to include the generic and brand name in many instances.
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