Etamsylate

Uses

Etamsylate is licensed for the prophylaxis and treatment of periventricular hemorrhage in neonates, in whom it is apparently effective [ , ]. In a multicenter, double-blind, placebo-controlled trial in 330 infants, intraventricular and parenchymal hemorrhages developed in 30/162 infants in the treated group (etamsylate 12.5 mg/kg 6-hourly from within 1 hour of delivery for 4 days), compared with 50/168 in the control group [ ]. The incidence of intraventricular and parenchymal hemorrhage in survivors was 20/137 after etamsylate and 37/146 in the controls. No adverse effects were attributed to etamsylate. In a double-blind, prospective follow-up of this study, 268 of 276 survivors of the original study were seen at 3.5–4.2 years of age [ ]. There was no difference between the groups in neuromotor outcome (cerebral palsy) or in the general cognitive index of the McCarthy scales; fewer of the children who were given etamsylate had squints or required surgery for patent ductus arteriosus.

Etamsylate is more widely used to treat menorrhagia, including that associated with use of intrauterine contraceptive devices [ ], although its efficacy has been challenged. A meta-analysis of drugs available in primary care showed that tranexamic acid was the most effective agent available for treatment of menorrhagia, while etamsylate was not associated with significant benefit [ ]. Guidelines published by the Royal College of Obstetricians and Gynaecologists in the UK stated that “at currently recommended doses, etamsylate is not an effective treatment for menorrhagia” [ ]. A significant proportion of women with primary menorrhagia turn out to have congenital disorders of coagulation, such as von Willebrand disease, and these cases do not respond to etamsylate [ ].

No clinical benefit for patients without bleeding disorders undergoing surgical procedures has been established [ ], although results in tonsillectomy have yielded conflicting results [ , ].