Oral tranexamic acid is taken as a tablet or capsule by mouth. It works systemically to address melasma by reducing melanin production throughout the body. Oral tranexamic acid medications, such as The Spot Pill, are especially useful for individuals with widespread or stubborn melasma that is challenging to treat with topical agents alone. Oral tranexamic acid can also be used during scheduled breaks from hydroquinone. While generally well-tolerated, it may not be suitable for individuals with certain medical conditions, such as a history of blood clots.