PO (Adults): 5g 1st hr, followed by 1-1.25g q hr for 8hr or until hemorrhage is controlled 

IV (Adults): 4-5g over 1st hr, followed by 1g/hr for 8hr or until hemorrhage is controlled 

PO (Adults): to follow IV--- 3g q 2hr (36g/day). If no surgery is performed, continue for 21 days after bleeding stops, then decrease to 2g q 2hr (24g/day) for 3 days

IV (Adults): 36g/day for 10 days followed by PO 

Pharmacologic: fibrinolysis inhibitors 

Use Cautiously in: Upper urinary tract bleeding; cardiac, renal, or liver disease; pregnancy and lactation; disseminated intravascular coagulation. 

EENT: nasal stuffiness, tinnitus

CV: arrythmias, hypotension

GI: anorexia, bloating, cramping, diarrhea, nausea

GU: diuresis, renal failure

MS: myopathy 

-       Monitor blood pressure, pulse, and respiratory status as indicated by severity of bleeding

-       Monitor for overt bleeding every 15-3-min

-       Monitor neurologic status in subarachnoid hemorrhage patients

-       Monitor intake and output ratios frequently

-       Monitor platelet count and clothing factors prior to and periodically throughout therapy

-       Monitor IV site closely. Stabilize IV catheter to minimize thrombophlebitis 

-       For intermittent infusion: Do not administer undiluted. Dilute initial 4-5g dose in 250ml of sterile water for injection

-       For continuous infusion: initial dose may be followed by a continuous infusion of 1g/hr in 50-100ml of diluent.

-       Instruct patient to notify the nurse immediately if bleeding recurs or if thromboembolic symptoms develop

-       IV: Caution patient to make position changes slowly to avoid orthostatic hypotension

-       Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy. Monitor ECG periodically during prolonged therapy

-       Monitor intake and output ratios and daily weight. Assess signs of CHF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular vein distention)

-       Angina: assess location, duration, intensity, and precipitating factors of patient’s anginal pain

-       PO: may be administered without regard to meals

Instruct patient to:

-       Take missed doses as soon as possible unless almost time for the next dose; do not double doses

-       Contact physician if pulse rate is <50bpm

-       Caution patient to change position slowly to prevent hypotension

-       Avoid attention seeking activities or requiring alert until response to medication is unknown

-       Maintenance of good dental hygiene

-       Avoid use of alcohol or OTC medications especially cold preparations

-       Wear sunscreen and protective clothing

-       Take blood pressure weekly and to report significant changes

-       Hypertension: encourage patient to comply with other interventions for hypertension (low-sodium diet, weight reduction, regular exercise, etc.)

Angina: instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks 

·         Deglin, JH., & Vallerand AH., (2007). Davis’s drug guide for nurses (tenth edition). FA Davis company Philadelphia, Pennsylvania. ISBN: 978-0-8036-1156-6

·         Wilson et al., 2007 Prentice Hall Nurse's Drug Guide. Pearson. 

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