Names and pronunciation
(hep′a-rin) Hepalean , Heparin Leo , Heparin Sodium Injection, Hep- Lock, Hep-Lock U/P, Monoject Prefil
Source page 643
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Individual generic drug information
Extracted information for heparin only.
(hep′a-rin) Hepalean , Heparin Leo , Heparin Sodium Injection, Hep- Lock, Hep-Lock U/P, Monoject Prefil
Source page 643
Func. class.: Anticoagulant, an- tithrombotic
Source page 643
Do not confuse: heparin/Hespan
Source page 643
ACTION: Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III
Source page 643
USES: Prevention treatment of deep venous thrombosis, PE, MI, open heart surgery, disseminated intravascular clot- ting syndrome, atrial fibrillation with embolization, as an anticoagulant in transfusion and dialysis procedures, to maintain patency of indwelling venipunc- H ture devices; diagnosis, treatment of DIC
Source page 643
Extracted information for heparin only.
CONTRAINDICATIONS: Bleed- ing, hypersensitivity to this product, corn, porcine protein (pork product) Precautions: Pregnancy, children, geri- atric patients, alcoholism, hyperlipidemia, diabetes, renal disease, heparin-induced thrombocytopenia (HIT), hemophilia, leukemia with bleeding, peptic ulcer dis- ease, severe thrombocytopenic purpura, severe renal/hepatic disease, blood dys- crasias, severe hypertension, subacute bacterial endocarditis, acute nephritis; benzyl alcohol products in neonates/ infants/pregnancy/lactation
Source page 643
SIDE EFFECTS CNS: Fever, chills, headache GU: Hematuria HEMA: Hemorrhage, thrombocytopenia, anemia, heparin-induced thrombocyto- penia (HIT) INTEG: Rash, dermatitis, urticaria, pruri- tus, alopecia, hematoma, cutaneous necrosis (SUBCUT), inj-site reactions META: Hyperkalemia, hypoaldosteron- ism, rebound hyperlipidemia, vitamin D deficiency GI: Elevated LFTs MS: Osteoporosis (child) SYST: Anaphylaxis
Source page 645
INTERACTIONS Increase: heparin action—oral antico- agulants, salicylates, dextran, NSAIDs, platelet inhibitors, cephalosporins, peni- cillins, ticlopidine, dipyridamole, anti- neoplastics, clopidogrel, SSRIs, SNRIs, quinidine, valproic acid Decrease: heparin action—digoxin, tet- racyclines, antihistamines, cardiac glyco- sides, nicotine, nitroglycerin Drug/Herb Increase: bleeding risk—arnica, anise, chamomile, clove, dong quai, garlic, ginger, ginkgo, feverfew, green tea, horse chestnut Drug/Lab Test Increase: ALT, AST, INR, PT, PTT, potassium Decrease: platelets
Source page 645
TREATMENT OF OVERDOSE: Withdraw product; administer 1 mg prot- amine/100 units heparin
Source page 646
Extracted information for heparin only.
DOSAGE AND ROUTES Anticoagulation • Adult: IV BOLUS (intermittent) 10,000 units, then 5000-10,000 q4-6hr CONTINUOUS IV INFUSION 5000 units, then 20,000-40,000 units give over 24 hr; SUBCUT 5000 units, then 10,000- 20,000 units, then 8000-10,000 q8hr • Child >1 yr: IV bolus (intermittent) 50-100 units/kg q4hr; continuous IV infusion 75 units/kg then 20 units/kg/hr, adjust to aPTT by 65-85 sec • Neonates, infants <1 yr: Continuous IV infusion 75 units/kg, then 28 units/ kg/hr, adjust to aPTT 65-85 sec Thromboembolism prevention • Adult: SUBCUT 5000 units q8-12hr CV surgery • Adult: IV ≥150 units/kg (300 units) for procedure <60 min, 400 units/kg for procedure ≥60 min Line flush • Adult/child: IV 10-100 units/mL (10 units: infants) to fill heparin lock TPN • Adult/child IV 0.5-1 units/mL
Source pages 643, 644
Available forms: Sol for inj 10, 100, 1000, 2000, 5000, 7500, 10,000, 20,000 units/mL; premixed 1000 units/500 mL, 2000 units/1000 mL, 12,500 units/250 mL, 25,000 units/250 mL, 25,000 units/500 mL; lock flush preparations 10 units/mL
Source page 644
Administer: • Cannot be used interchangeably (unit for unit) with LMWHs or heparinoids • At same time each day to maintain steady blood levels; always check dose with another nurse before use or a change in dose • Store at room temperature Heparin lock route • Do not mistake heparin sodium inj 10,000 units/mL and Hep-Lock U/P 10 units/mL; they have similar blue labeling; deaths in pediatric patients have occurred when heparin sodium inj vials were con- fused with heparin flush vials • Inject to prevent clots in heparin lock; inject dilute heparin solution 10-100 units/0.5-1 mL after each injection or q8hr flush lock before and after each use with sterile water or 0.9% NaCl SUBCUT route • Give deeply with 25-G 3⁄8-½-in needle; do not massage area or aspirate when giving SUBCUT inj; give in abdomen be- tween pelvic bones, inject at 45- or 90-degree angle, rotate sites; do not pull back on plunger; apply gentle pressure for 1 min • Changing needles is not recom- mended • Do not give IM • Avoid all IM inj that may cause bleed- ing, hematoma Direct IV route • Give loading dose undiluted, over ≥1 min; use before continuous infusion Continuous IV INFUSION route • Obtain baseline coagulation tests be- fore use • Use infusion pump; make sure pressure dressings are used after drawing blood • Draw coagulation studies 30 min be- fore next dose; never draw from tubing or from infused vein; use other arm • Dilute 25,000 units/250-500 mL 0.9 NaCl or D5W; 50-100 units/mL solutions are premixed and ready for use • When product is added to infusion sol for cont IV, invert container at least 6 times to ensure adequate mixing Y-site compatibilities: Acetaminophen, ace- tylcysteine, acyclovir, alcohol 10%, dextrose 5%, alemtuzumab, alfentanil, allopurinol, amifostine, aminocaproic acid, aminophyl- line, amphotericin B lipid complex, ampho- tericin B liposome, anidulafungin, argatro- ban, arsenic trioxide, ascorbic acid injection, asparaginase, atenolol, atropine, azaTHIOprine, azithromycin, aztreonam, benztropine, betamethasone, bivalirudin, bleomycin, bretylium, bumetanide, buprenorphine, butorphanol, caffeine, cal- cium chloride/gluconate, cangrelor, CAR- BOplatin, carmustine, cefamandole, ceFAZolin, cefotaxime, cefoTEtan, cefotiam, cefOXitin, ceftaroline, cefTAZidime, ceftizox- ime, ceftobiprole, cefTRIAXone, cefu roxime, chloramphenicol succinate, chlordiazePOXIDE, chlorothiazide, chlor- pheniramine, cimetidine, CISplatin, cladrib- ine, clindamycin, cloxacillin, codeine, colistimethate, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOrubi- cin citrate liposome, dexamethasone, dex- medetomidine, dexrazoxane, digoxin, DOCEtaxel, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin lipo- somal, edetate calcium disodium, edropho- nium, enalaprilat, ePHEDrine sulfate, EPI- NEPHrine, epoetin alfa, eptifibatide, ergonovine, ertapenem, esmolol, estrogens conjugated, ethacrynate, etoposide, etopo- side phosphate, famotidine, fenoldopam, fentaNYL, flecainide, fluconazole, fludara- bine, fluorouracil, folic acid (as sodium salt), foscarnet, gallamine, gallium, ganci- clovir, gemcitabine, gemtuzumab, glycopyr- rolate, granisetron, hydrocortisone, HYDROmorphone, ibuprofen lysine, ifos- famide, imipenem-cilastatin, indomethacin, irinotecan, isoproterenol, ketorolac, lac- tated Ringer’s injection, lansoprazole, leu- covorin, lidocaine, lincomycin, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, mephenter- mine, meropenem, mesna, metaraminol, methadone, methohexital, methotrexate, methoxamine, methyldopate, methylergo- novine, metoclopramide, metoprolol, met- roNIDAZOLE, micafungin, midazolam, mil- rinone, minocycline, mitoMYcin, mivacurium, morphine, moxifloxacin, mul- tiple vitamins injection, nafcillin, nalbu- phine, nalorphine, naloxone, neostigmine, nitroglycerin, nitroprusside, norepineph- rine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel (solvent/ surfactant), palonosetron, pamidronate, pancuronium, PEMEtrexed, penicillin G potassium, sodium, PENTobarbital, PHENo- barbital, phentolamine, phenylephrine, phy- tonadione, piperacillin sodium, piperacillin- tazobactam, potassium acetate/chloride, procainamide, prochlorperazine, proma- zine, propofol, propranolol, pyridostigmine, pyridoxine, raNITIdine, remifentanil, Ring- er’s injection, riTUXimab, rocuronium, sar- gramostim, scopolamine, sodium acetate, bicarbonate/fusidate, succinylcholine, SUFentanil, tacrolimus, theophylline, thia- mine, thiopental, thiotepa, ticarcillin, ticar- cillin-clavulanate, tigecycline, tirofiban, tolazoline, topotecan, TPN (2-in-1), tranexamic acid, trastuzumab, trimetaphan, trimethobenzamide, tubocurarine, uroki- nase, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, voriconazole, war- farin, zidovudine, zoledronic acid
Source pages 644, 645
Extracted information for heparin only.
Assess: • Bleeding, hemorrhage: gums, petechi- ae, ecchymosis, black tarry stools, hematu- ria, epistaxis, decrease in Hct, B/P; HIT may occur after product discontinuation; check periodically for sign of decreasing clots • Blood studies (Hct, occult blood in stools) q3mo • Thrombosis: monitor for increased thrombosis daily, in affected areas • Partial prothrombin time, which should be 1.5-2.5× control; for continuous IV infu- sion, check aPTT baseline 6 hr after initiation and 6 hr after any dose change; use aPTT for dosing adjustments; after therapeutic aPTT has been measured 2×, check aPTT daily • Heparin-induced thrombocytopenia (HIT): platelet count q2-3days; thrombocy- topenia may occur on 4th day of treatment and resolves even during continued treat- ment; HIT may occur on the 5th-10th day of treatment, with platelets to 5000 mm3; this may lead to HITT (venous/arterial thrombo- sis) even after discontinued therapy • Hypersensitivity: rash, chills, fever, itching; report to prescriber
Source pages 645, 646
Evaluate: • Therapeutic response: prevention of DVT and pulmonary emboli; adequate anticoagulation based on aPTT, PTT 1.5- 2.5× control
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid OTC preparations that may cause serious product interactions un- less directed by prescriber; to notify all health care providers of heparin use • That product may be held during ac- tive bleeding (menstruation), depending on condition • About subcut injection technique if self-administered; to rotate sites, not to inject into irritated or broken skin • To use soft-bristle toothbrush to avoid bleeding gums; to avoid contact sports; to use an electric razor; to avoid IM inj • To carry emergency ID identifying product taken • Bleeding: to report to prescriber any signs of bleeding: gums, under skin, urine, stools • To report to prescriber any signs of hypersensitivity: rash, chills, fever, itching
Source page 646
Extracted information for heparin only.
PHARMACOKINETICS Half-life 1-2 hr (dose dependent); excreted in urine; 95% bound to plasma proteins; does not cross placenta or alter breast milk; removed from the system via the lymph and spleen; partially metabolized in kidney, liver; excreted in urine (<50% unchanged) H SUBCUT: Onset 20-60 min, peak 2-4 hr duration 8-12 hr, well absorbed >35,000 IU/24 hr IV: Peak 5 min, duration 2-6 hr
Source page 645
Filter the extracted dose blocks for this individual drug.
Anticoagulation
• Neonates, infants <1 yr: Continuous IV infusion 75 units/kg, then 28 units/ kg/hr, adjust to aPTT 65-85 sec Thromboembolism prevention
Candidate age grouping · source pages 643, 644