Etamsylate

Uses and Administration

Etamsylate is a haemostatic that appears to maintain the stability of the capillary wall and correct abnormal platelet adhesion. It is given for the prophylaxis and control of haemorrhages from small blood vessels.

For short-term treatment of blood loss in menorrhagia ( Refer to ) a dose of 500 mg is given orally four times daily during menstruation. For the control of haemorrhage after surgery etamsylate may be given orally or by intramuscular or intravenous injection in a dose of 250 to 500 mg. A dose may be given 1 hour before surgery, and further doses given after surgery and repeated every 4 to 6 hours as necessary. Intravenous doses may be given during surgery if necessary. For etamsylate use in prophylaxis of neonatal intraventricular haemorrhage, see Refer to .

(last reviewed 2010-07-26; last modified 2010-07-05)

Administration in children

For information on etamsylate prophylaxis of intraventricular haemorrhage in premature neonates, see Refer to .

(last reviewed 2010-07-26; last modified 2010-06-17)

Menorrhagia

When given during menstruation to women with idiopathic menorrhagia ( Refer to ), etamsylate was as effective as mefenamic acid in reducing uterine blood loss in 1 study,1 but was ineffective in another.2 A review, which included published and unpublished results from these and 2 earlier studies, reported that etamsylate produced about a 10 to 15% reduction in menstrual blood loss.3Etamsylate is now considered to be less effective than other treatments for menorrhagia, and is no longer recommended.4

(last reviewed 2010-07-26; last modified 2008-07-03)

References

1. Chamberlain G, et al.. A comparative study of ethamsylate and mefenamic acid in dysfunctional uterine bleeding.Br J Obstet Gynaecol. 1991; 98: 707–11. PubMed

2. Bonnar J, Sheppard BL. Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid.BMJ. 1996; 313: 579–82. PubMed

3. Coulter A, et al.. Treating menorrhagia in primary care: an overview of drug trials and a survey of prescribing practice.Int J Technol Assess Health Care. 1995; 11: 456–71. PubMed

4. National Collaborating Centre for Women's and Children's Health/NICE. Heavy menstrual bleeding (issued January 2007). Available at: Link (accessed 06/03/08)

Neonatal intraventricular haemorrhage

Etamsylate is one of several drugs that have been tried in the prevention of intraventricular haemorrhage in very low birth-weight infants ( Refer to ). In some countries it is licensed for intramuscular use in doses of 10 mg/kg. The first dose is given within the first 2 hours after birth, and repeated every 6 hours for 4 days.

Some studies have used mainly the intravenous route. In a multicentre, placebo-controlled, double-blind study,1 etamsylate was given in an initial dose of 12.5 mg/kg intravenously or intramuscularly within 1 hour of delivery, followed by the same dose intravenously every 6 hours for 4 days to a total dose of 200 mg/kg. Of 330 infants who had had no evidence of haemorrhage soon after delivery, the subsequent incidence of haemorrhage in the 162 who received etamsylate was reduced, particularly the more extensive grades when compared with the 168 who received placebo. Of a further 30 infants with evidence of periventricular haemorrhage before treatment, 21 were given etamsylate and 9 placebo; treatment with etamsylate limited the extension of bleeding. There was also a reduction in patent ductus arteriosus in the treated infants. However, a subsequent study using the same dosage regimen,2 showed little benefit on short-term follow-up. It was considered that the study size may have been too small and the drug given too late; the initial dose was given within 4 hours of birth whereas, in the previous study, treatment was started within 1 hour of birth. Follow-up3 of these infants at 2 years of age found that etamsylate had not reduced the risk of death, impairment, or disability. Developmental outcome assessments at about 4 years of age in patients from the first study4 also found that despite the original reduction in intraventricular haemorrhage with etamsylate, it had not reduced cerebral palsy compared with the control group.

(last reviewed 2010-07-26; last modified 2010-06-24)

References

1. Benson JWT, et al.. Multicentre trial of ethamsylate for prevention of periventricular haemorrhage in very low birthweight infants.Lancet. 1986; ii: 1297–1300. PubMed

2. The EC Ethamsylate Trial Group. The EC randomised controlled trial of prophylactic ethamsylate for very preterm neonates: early mortality and morbidity.Arch Dis Child. 1994; 70: 201–F205. PubMed

3. Elbourne D, et al.. Randomised controlled trial of prophylactic etamsylate: follow up at 2 years of age.Arch Dis Child Fetal Neonatal Ed. 2001; 84: 183–F187. PubMed

4. Schulte J, et al.. Developmental outcome of the use of etamsylate for prevention of periventricular haemorrhage in a randomised controlled trial.Arch Dis Child Fetal Neonatal Ed. 2005; 90: 31–F35. PubMed

Adverse Effects, Treatment and Precautions

Adverse Effects and Precautions

Nausea, vomiting, diarrhoea, fever, headache, and rashes have occurred after use of etamsylate. Headache and rashes may disappear on reduced dosage, and gastrointestinal disturbances are reduced by giving etamsylate after food. Transient hypotension has been reported after intravenous injection.

(last reviewed 2010-07-26; last modified 2010-06-17)

Pharmacokinetics

Etamsylate is absorbed from the gastrointestinal tract. It is excreted unchanged, mainly in the urine. Etamsylate is distributed into breast milk.

(last reviewed 2010-07-26; last modified 2005-09-29)

Therapeutic Use

• Blood Products Plasma Expanders and Haemostatics

Last Updated 1/21/20