Tranexamic acid (oral) — Supplement brief

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— § 02

What the literature shows.

Melasma severity (MASI score)

Three 2024–25 RCTs, 250 mg × 2/d

Consistent, replicated reduction in pigment over 8–12 weeks. Pairs cleanly with topical hydroquinone and azelaic.

85%

Melasma adjunct to laser

Comparator trials

Reduces post-laser PIH risk and rebound pigmentation. The peri-procedure data is now strong.

75%

PIH (post-acne)

Small RCTs

Promising adjunct in skin of colour. Less robust than melasma data; reasonable trial.

55%

General 'glow' / brightening

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Not the indication. Use topical actives for non-melasma tone work.

10%

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— § 03

Forms and bioavailability.

Tranexamic 250 mg tablet

Absorption · Standard

Two tablets daily, 12 hours apart. Course of 8–12 weeks; reassess.

Tranexamic 500 mg tablet

Absorption · Standard

Used in heavier menstrual bleeding indications; melasma protocol uses lower per-dose strength.

Tranexamic 5% topical

Absorption · Topical only

Adjunct, not replacement. Useful in pregnancy when oral is contraindicated.

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— Cross-references

Where it appears.

Concerns that recommend it

Melasma

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Bottom line

The single supplement most worth a dermatology consultation in 2026. Useful, well-studied, and decisively a treatment — not a wellness product.

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— § 04

Frequently asked.

What is the screening before starting?

Any personal or family history of venous thromboembolism, stroke, retinal vein occlusion, or active anticoagulation use is a contraindication. Smokers, women on combined oral contraceptives, and those with thrombophilias need a dermatologist-led decision. Most healthy adults can take it; the screen exists to find the small minority who cannot.

How long does the course run?

8–12 weeks for the initial course. If there is meaningful response, a maintenance dose of 250 mg/d may continue for another 8–12 weeks. Indefinite use is rarely indicated; most patients cycle off and rely on topicals plus SPF for maintenance.

Can I combine with topical hydroquinone?

Yes — the standard combination protocol is oral tranexamic + topical hydroquinone 4% + tretinoin (the modified Kligman cocktail), with rigorous SPF. Combination outperforms any single arm in melasma trials.

Side effects to watch for?

GI upset is the most common (5–10%). Thrombotic events are rare in screened patients but the reason for the screen. Headache and menstrual irregularity occur in a small minority.