Tranexamic acid
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Reviewed on September 12, 2023. by
Dr Alexandra Cristina Cowell
Writer & Clinical Content Reviewer
Next review due on
September 11, 2025.
Dr Alexandra Cristina Cowell

Product info

  • Tranexamic acid was originally used to control bleeding, but it’s shown promise treating melasma.

  • It interferes with the production of enzymes involved in making melanin (which darkens your skin).
  • It can be used alone, or in combination with other treatments for melasma.

Tranexamic acid Tranexamic acid

What is tranexamic acid?

Tranexamic acid is a medicine that’s commonly used to control bleeding. Developed in 1962 by Japanese researchers, its wide range of uses (such as helping to prevent blood loss for trauma patients in hospitals to treating heavy periods or nosebleeds for people at home) have led the WHO to place it on their list of essential medicines.[1] It’s available on prescription in the form of tablets, liquid, mouthwash and (in hospital settings) injections.

More recently, it’s been shown to be a safe and effective treatment for certain conditions related to skin pigmentation, such as melasma. It may be prescribed by dermatologists to even out your skin tone (in low doses). According to recent studies, it can work for up to nine in ten people, without many risks.[2] But it’s still an ‘off-label’ treatment when used for skin conditions. This means that tranexamic acid isn’t licensed to treat skin conditions, but dermatologists can still prescribe it for this purpose if they think it’ll be safe for you.

How does tranexamic acid work?

For its licensed uses, tranexamic acid works by supporting your body’s natural clotting process, which speeds up the rate at which you stop bleeding. But for dermatological conditions, it’s not fully known how it works to improve symptoms. A commonly held theory is that it works by both causing your skin’s blood vessels to become smaller, and reducing your melanin production (the pigment that gives skin its colour). It does this by changing the way certain skin cells (keratinocytes and melanocytes) interact with each other, and by decreasing the activity of an enzyme called tyrosinase.

What doses of tranexamic acid are there?

Tranexamic acid comes as 500mg tablets. Typically, for something like heavy periods, you’ll be advised to take two or three tablets, three times a day while you’re on your period. However, for melasma, the recommended daily dosage is much lower – 500mg per day. You may be advised to split this across two doses (of 250mg each), one in the morning and one at night. Your dermatologist will give you precise instructions on how best to take tranexamic acid to suit your needs.

Treated trusted sources:

  1. World Health Organisation – Electronic Essential Medicines List.
  2. Patil, S.J. (2018). Safety and Efficacy Profile of Oral Tranexamic Acid v/s Tranexamic Acid Soaks v/s Tranexamic Acid Cream in Treatment of Melasma – A Hospital Based Prospective Randomised Controlled Comparative Study. Journal of Medical Science and Clinical Research, 6(2).
treated.com This page was written by The Treated Content Team.
Dr Alexandra Cristina Cowell
This page was medically reviewed by Dr Alexandra Cristina Cowell on September 12, 2023. Next review due on September 11, 2025.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

Tranexamic acid Tranexamic acid

How to use Tranexamic acid for melasma

Make sure to follow your dermatologist’s instructions carefully when taking tranexamic acid for melasma.

To take the tablets, simply swallow them whole, with water. You can take it with or without food. Try to spread your doses evenly across the day.

If you’re taking the liquid, it will come with a plastic syringe or spoon to help you measure out your dose. Don’t use a kitchen spoon as the dose won’t be accurate. (If your treatment didn’t come with a syringe or spoon, ask your pharmacist for one.)

For melasma, tranexamic acid can be taken orally or used topically (applied directly to your skin). Oral tranexamic acid is off-label, and should only be prescribed by a licensed clinician. They’ll decide how much you should use (and how long for) based on your medical profile.

How long before it starts to work?

The length of time it takes tranexamic acid to work will depend on what you’re using it to treat. For reducing bleeding, it can take up to 24 hours for it to work fully, but for skin conditions it’ll take a bit longer.

Tranexamic acid is generally safe to use for extended periods of time. For conditions where longer treatment periods are needed, it’ll take eight to 12 weeks of consistent treatment before you start to see the full effects of it. If your skin hasn’t improved after this time, speak to your dermatologist.

What should I do if I take too much or miss a dose?

If you forget your dose of tranexamic acid, take it as soon as you remember (unless it’s nearly time for your next dose). If it is, simply skip that dose and carry on as normal. Don’t take a double dose to make up for the forgotten one. If you often find yourself missing doses, you might find it useful to set an alarm to remind you.

If you do accidentally take an extra dose of tranexamic acid, it’s unlikely to cause any problems. However if you take too much it can cause side effects, such as nausea, sickness, diarrhoea and dizziness. Seek medical help if you’re worried or these side effects are concerning you.

treated.com This page was written by The Treated Content Team.
Dr Alexandra Cristina Cowell
This page was medically reviewed by Dr Alexandra Cristina Cowell on September 12, 2023. Next review due on September 11, 2025.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

Tranexamic acid Tranexamic acid

Tranexamic acid isn’t suitable for everyone, and there are some things that you need to be aware of when taking it.

Here’s all the official info on it. If anything is unclear, let our clinician know, and they can talk with you about it.

Tranexamic acid Tranexamic acid

FAQ: Tranexamic acid

Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.

Can I take Tranexamic acid with iron tablets?

Answer:
Tranexamic acid doesn’t interact with ferrous salts (the active ingredients in iron tablets), so it should be safe for you to take both of these treatments at the same time to keep your iron levels up.[2] Contact your clinician if you’re not sure whether tranexamic acid might interfere with any other treatments you’re taking.

Will I get side effects from Tranexamic acid?

Answer:
Most people don’t get any side effects from treatment with tranexamic acid. If they do get any, they tend to only be mild. 

If you’re taking the combined pill, there’s a very small increased risk of DVT (deep vein thrombosis) when you take it alongside tranexamic acid. So it’s important to let your clinician know if you get any signs of a blood clot during your treatment, such as pain, swelling or tenderness in one of your legs.

How effective is Tranexamic acid at treating melasma?

Answer:
Tranexamic acid has been shown to be effective at treating melasma, even in low doses for short periods of time. One study found that its success rate at treating melasma was 89% after just eight weeks. When those studied stopped taking tranexamic acid, symptoms returned for 27% of them. [1]

Can I get Tranexamic acid over the counter?

Answer:
Tranexamic acid tablets are a prescription-only treatment in the UK, so you’ll need to speak to a clinician before you can get them to make sure they’re right for you. You can, however, get topical treatments (applied directly to the skin) that contain tranexamic acid over the counter online and in pharmacies without a prescription. These are typically used for hyperpigmentation.

What is Tranexamic acid used for?

Answer:
In recent years, dermatologists have started to recommend tranexamic acid for various skin conditions, such as melasma.

However tranexamic acid is still mostly used to stop bleeding. Because it helps your blood to clot, it’s most often used for heavy periods, but it can be prescribed for nosebleeds too. And if you’re at the dentist, there’s a good chance they’ll have it there as well – in the form of a mouthwash. (When you’re having a tooth taken out, tranexamic acid mouthwash can help to stop the bleeding.)

Alongside those uses, it’s sometimes also used for a condition that causes swelling under your skin, called hereditary angioedema. It’s also given to stop bleeding in childbirth, or before surgery in people who have a condition that makes them bleed a lot.

Treated trusted sources:

  1. Patil, S.J. (2018). Safety and Efficacy Profile of Oral Tranexamic Acid v/s Tranexamic Acid Soaks v/s Tranexamic Acid Cream in Treatment of Melasma – A Hospital Based Prospective Randomised Controlled Comparative Study. Journal of Medical Science and Clinical Research, 6(2).
  2. www.medicines.org.uk. (2018). Tranexamic Acid 500 mg film coated tablets – Summary of Product Characteristics (SmPC) – (emc).

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