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What are the side effects of long-term use of tranexamic acid for melasma treatment?

Nov 29, 2025 Source: Cainiu Health
Dr. Liu Wenmin
Introduction
In general, long-term use of tranexamic acid for skin whitening may lead to gastrointestinal discomfort, affect the blood system, cause dry or itchy skin, result in abnormal liver function, and cause menstrual disorders. Tranexamic acid may irritate the gastrointestinal mucosa, and prolonged use can easily cause symptoms such as nausea, vomiting, diarrhea, and abdominal pain. Some individuals may also experience loss of appetite, affecting normal digestive function.

Under normal circumstances, long-term use of tranexamic acid for freckle removal may lead to gastrointestinal discomfort, affect the blood system, cause dry or itchy skin, result in abnormal liver function, and cause menstrual disorders. The specific analysis is as follows:

1. Gastrointestinal discomfort: Tranexamic acid may irritate the gastrointestinal mucosa. Long-term use can easily lead to symptoms such as nausea, vomiting, diarrhea, and abdominal pain. Some individuals may also experience loss of appetite, affecting normal digestive function, which over time could impair nutrient absorption.

2. Effects on the blood system: As an antifibrinolytic drug, long-term use of tranexamic acid may affect blood coagulation function and increase the risk of thrombosis, especially among individuals with a history of thrombosis or hypercoagulable states. In rare cases, it may also lead to thrombocytopenia and a tendency to bleed.

3. Skin dryness or itching: Some individuals may develop skin adverse reactions after prolonged use of tranexamic acid, manifesting as dry, flaky skin or mild itching. In severe cases, this may compromise the skin barrier function, increasing the risk of skin sensitivity or infection.

4. Abnormal liver function: Since the drug is metabolized by the liver, long-term use of tranexamic acid may increase the liver's workload, leading to abnormal liver function indicators such as elevated transaminase levels. A small number of individuals may develop symptoms like jaundice, necessitating regular monitoring of liver function.

5. Menstrual disorders: Tranexamic acid may affect hormone levels or coagulation-related mechanisms in the body. Women who take it long-term may experience menstrual cycle disturbances, including reduced menstrual flow, prolonged periods, or amenorrhea. In some cases, menstrual cycles may gradually return to normal after discontinuation.

Tranexamic acid should be used strictly under medical supervision for freckle removal; self-administered long-term use or dosage adjustments are not recommended. Regular blood tests and liver function tests should be performed during treatment to monitor bodily indicators. If significant adverse symptoms occur, discontinue the drug immediately and seek medical attention promptly.

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