How Long Does It Take For Oral Tranexamic Acid To Improve Melasma?

Oral tranexamic acid (OTA) is a synthetic drug initially FDA approved to treat bleeding disorders, but it has also been found to treat melasma and other hyperpigmentation disorders effectively (Chauncey). Today, dermatologists prescribe oral tranexamic acid at low dosages to help reduce melasma and provide a clearer and more even skin tone.

Since there is no cure for melasma, how long should you take oral tranexamic acid to see visible gains? Also, if you must take it indefinitely, are there any safety concerns you should be aware of? This article answers all those questions and more. Let’s dig in.

How long should you take oral tranexamic acid for melasma to see gains?

Oral tranexamic acid treatment benefits maximize after taking it for eight to twelve weeks. During this time, it limits a cellular process involved in producing melanin, the pigment that makes your skin dark and causes freckles.

One meta-analysis found that if subjects kept taking oral tranexamic acid, melasma signs remained reduced (Wang). However, since the melanin production process is just paused, once they stopped taking the medication, the melanin process kicked back in, and the dark spots and darkening returned. These findings show that individuals who want to continue experiencing the benefits of OTA must continue taking it as a long-term treatment.

The specifics of long-term management are highly individualized. For example, in some cases, your doctor might prescribe oral tranexamic acid in batches of several weeks or months and then ask you to come in for a review. In other cases, they might decide to give you a break from the medication every few months to give your body a rest.

Considering it can take up to three months for melasma signs to return after stopping the medication, your doctor will advise you on how long you should take it and whether to pause your prescription every few months.

Will taking oral tranexamic acid for melasma cure it?

Oral tranexamic acid works by reducing the amount of melanin your skin produces. However, this reduction is not permanent. Taking it slows down melanin production, but only for as long as it is available in the body.

Since the body only utilizes a small fraction of the drug (around 10%) and the rest leaves the body via urinary excretion, you have to keep taking it to maintain useful levels within the body. However, even though oral tranexamic acid does not cure melasma, it significantly reduces its signs without any significant side effects.

Oral tranexamic acid is currently considered safe for long-term use at low dosage levels, with few minor side effects reported by those taking it. The ability to take OTA for prolonged periods can be as effective as an actual cure, especially if you tolerate the drug well and your doctor approves it for long-term treatment.

Are there long-term dangers of taking oral tranexamic acid for melasma?

Although there are multiple short-term trials on the effects of oral tranexamic acid, there isn’t yet enough data on its long-term effects. FDA approvals primarily focused on one-time uses such as treating heavy periods or postoperative bleeding, so there isn’t enough data to determine the drug’s long-term effects.

However, doctors have been prescribing oral tranexamic acid for melasma for decades, so anecdotal evidence suggests it is safe for long-term use. Nevertheless, for your safety, your doctor might prescribe oral tranexamic acid either for a limited period or as long-term treatment with periodic reviews.

If you have additional concerns based on an underlying medical condition or other drugs you are taking, speak to your dermatologist to explore the best way forward.

What is the best way to take oral tranexamic acid as a melasma treatment?

The best way to take oral tranexamic acid for melasma is to speak with your dermatologist and obtain a prescription. As a prescription-only drug used as an ‘off-label’ medication, your dermatologist will weigh all options based on your medical history, treatment needs, and other factors to determine whether you should take it.

If they determine that the risk might be too high, they will explain this to you and provide safer alternatives. If you are currently taking oral tranexamic acid, it’s important to get periodic reviews to ensure that you are still using the correct dosage and, and have your prescription adjusted if necessary.

References

• Chauncey JM, Wieters JS. Tranexamic Acid. [Updated 2021 Jul 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532909/
• Wang JV, Jhawar N, Saedi N. Tranexamic Acid for Melasma: Evaluating the Various Formulations. J Clin Aesthet Dermatol. 2019;12(8):E73-E74.

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.