Safety
Not with combined hormonal contraception (the pill, patch or ring), and not if you have or have had blood clots or have a clotting risk, including retinal vein or artery occlusion: the label contraindicates all of these. Clots and retinal occlusion have been reported, so stop and get care for any change in vision. It is not indicated in pregnancy.
Talk to a licensed clinician about your health history and every medication you take before you start.
Legal status
Prescription only; FDA-approved. FDA-approved and generic for heavy menstrual bleeding; melasma is an off-label use with a clot-risk contraindication that often applies to people on the pill. Not a controlled substance.
What Oral tranexamic acid for melasma is
Oral tranexamic acid for melasma contains tranexamic acid. Melasma is an off-label use. The approved tablets are 650 mg; low-dose capsules sold for melasma are compounded and not FDA-approved.
FDA-approved for cyclic heavy menstrual bleeding (650 mg tablets).
Dosing
Tablet or capsule, taken by mouth, twice a day in melasma studies. In the Del Rosario trial: 250 mg twice a day for 3 months, with sunscreen. The approved bleeding dose is 1,300 mg three times a day for up to 5 days a month. Your clinician sets the dose for you.
How well it works
In a 3-month placebo-controlled trial of 44 patients (J Am Acad Dermatol, 2018), 250 mg twice a day cut melasma severity scores (mMASI) by 49%, against 18% on placebo. Three months after stopping, the reduction from baseline was 26% vs 19%. Individual results vary.
Oral tranexamic acid for melasma cost
None of the online providers we compare publishes a monthly price for it. For a full breakdown, read How much does an online dermatologist cost?. For the steps, read How to get a tretinoin prescription online.