OTC tranexamic acid for heavy menstrual bleeding – an update

We recently reviewed tranexamic acid 500mg tablets as an over-the-counter (OTC) treatment for heavy menstrual bleeding.1 At the time we went to press, it was not known when the drug would become available for OTC sale, nor how much it would cost. It was subsequently announced that the drug (under the brand name Cyklo-F) was to be made available from 31 January 2011, exclusively from Boots pharmacies for the first 15 months. This product costs £8.99 for a pack of 18 tablets.1 It was later announced that another brand (Femstrual) will become available for sale from all pharmacies in early March 2011 at a cost of £7.95 for a pack of 18 tablets.2 We concluded previously that the availability of tranexamic OTC was likely to be an advantage for women who want to try a drug treatment for heavy menstrual bleeding without having to consult a doctor. A single OTC pack contains enough tablets for 3 days' treatment at the usual dose (1g three times daily), but not enough for a woman with heavy bleeding who needs the maximum dose (1g four times daily for 4 days). The OTC cost is more than the £7.20 NHS prescription charge in England. Women who want to try the drug may therefore prefer to visit their GP, especially if they do not pay prescription charges; this means that the OTC availability of tranexamic acid might not be such an advantage after all.