Heparin

Indications
Subcutaneous
Venous thromboembolism
Adult: 15,000 u injected every 12 hr.
Child: 250 u/kg every 12 hr.
Subcutaneous
Prophylaxis of postoperative venous thromboembolism
Adult: 5000 u given 2 hr before surgery then every 8-12 hr for 7 days or until the patient is ambulant, may increase to 10,000 u every 12 hr during the 3rd trimester of pregnancy.
Subcutaneous
Prophylaxis of mural thrombosis
Adult: 12,500 u every 12 hr for at least 10 days.
Intravenous
Unstable angina
Adult: 5000 u (10,000 u in severe pulmonary embolism) IV loading dose followed by 1000-2000 u/hr continuous infusion. Alternatively, intermittent inj of 5000-10,000 u every 4-6 hr.
Child: Administer a lower loading dose. Maintenance: 15-25 u/kg/hr continuous infusion.
Intravenous
Venous thromboembolism
Adult: 5000 u (10,000 u in severe pulmonary embolism) IV loading dose followed by 1000-2000 u/hr continuous infusion. Alternatively, intermittent inj of 5000-10,000 u every 4-6 hr.
Child: Administer a lower loading dose. Maintenance: 15-25 u/kg/hr continuous infusion.
Intravenous
Peripheral arterial embolism
Adult: 5000 u (10,000 u in severe pulmonary embolism) IV loading dose followed by 1000-2000 u/hr continuous infusion. Alternatively, intermittent inj of 5000-10,000 u every 4-6 hr.
Child: Administer a lower loading dose. Maintenance: 15-25 u/kg/hr continuous infusion.
Intravenous
Prophylaxis of re-occlusion of the coronary arteries following thrombolytic therapy in myocardial infarction
Adult: 5000 u IV followed by 1000 u/hr IV with alteplase.

Incompatibility: Heparin calcium or sodium is reported to be incompatible with alteplase, reteplase, amikacin sulfate, amiodarone hydrochloride, ampicillin sodium, aprotinin, benzylpenicillin potassium or sodium, cefalotin sodium, ciprofloxacin lactate, cytarabine, dacarbazine, daunorubicin hydrochloride, diazepam, dobutamine hydrochloride, doxorubicin hydrochloride, droperidol, erythromycin lactobionate, gentamicin sulfate, haloperidol lactate, hyaluronidase, hydrocortisone sodium succinate, kanamycin sulfate, meticillin sodium, netilmicin sulfate, some opioid analgesics, oxytetracycline hydrochloride, some phenothiazines, polymyxin B sulfate, streptomycin sulfate, tetracycline hydrochloride, tobramycin sulfate, vancomycin hydrochloride and vinblastine sulfate. Heparin sodium has also been reported to be incompatible with cisatracurium besilate, labetalol hydrochloride, levofloxacin, nicardipine hydrochloride and vinorelbine tartrate.
Contraindications
Patients predisposed to active bleeding including thrombocytopenia, peptic ulcer disease, cerebrovascular disorders, haemorrhagic blood disorders, bacterial endocarditis, severe hypertension, oesophageal varices. Recent surgery at sites where haemorrhage would be an especial risk. Severe renal and hepatic impairment. Cerebral or subarachnoid haemorrhage, abdominal or thoracic bleeding into closed space, severe traumatic bleed, hepatic, renal, splenic or arterial injury, severe haemostatic defect, arterial thrombosis with heparin-associated thrombocytopenia. IM admin.
Warnings / Precautions
Monitor platelet counts. Discontinue treatment if thrombocytopenia occurs. Hypersensitivity, elderly, pregnancy.
Adverse Reactions
Slight fever, headache, chills, nausea, vomiting, constipation, epistaxis, bruising, slight haematuria, skin necrosis (SC inj), osteoporosis, alopecia. Hypersensitivity reactions include urticaria, conjunctivitis, rhinitis, asthma, angioedema and anaphylactic shock. Priapism.
Potentially Fatal: Heparin-induced thrombocytopenia with or without thrombosis; bleeding.
Overdose Reactions
Slight haemorrhage can be treated by withdrawing heparin. Severe bleeding may be treated with IV protamine sulfate.
Drug Interactions
Inhibited by zinc. Antiplatelet drugs e.g. aspirin and dipyridamole may precipitate bleeding.
Potentially Fatal: NSAIDs may increase risk of haemorrhage. Effect increased by dextrans, high doses of penicillin and cephalosporins, phenylbutazone, asparaginase. streptokinase and some contrast media.
See Below for More heparin Drug Interactions
Mechanism of Actions
Heparin increases the inhibitory action of antithrombin III (AT III) on clotting factors XIIa, XIa, IXa, Xa and thrombin. This inhibits the conversion of prothrombin to thrombin and fibrinogen to fibrin. It also inhibits platelet function. It may reduce the activity of ATIII at very high doses.
Absorption: Absorbed from systemic circulation (IV, SC).
Distribution: Reticuloendothelial system. Protein-binding: Extensive.
Excretion: Via urine (as metabolites, or up to 50% as unchanged after admin of large doses); 1-6 hr (elimination half-life), prolonged in renal impairment, decreased in pulmonary embolism, increased or decreased in hepatic impairment.
Storage Conditions
Intravenous: Store at 15-30°C. Subcutaneous: Store at 15-30°C.
ATC Classification
C05BA03 - heparin ; Belongs to the class of heparins or heparinoids used topically in antivaricose therapy.
S01XA14 - heparin ; Belongs to the class of other ophthalmologicals.
B01AB01 - heparin ; Belongs to the class of heparin group. Used in the treatment of thrombosis.
Storage
Intravenous: Store at 15-30°C. Subcutaneous: Store at 15-30°C.
Available As
  • Heparin Sodium 10 iu
  • Heparin Sodium IP 10 iu
  • Heparin Sodium 100 iu
  • Heparin 1000 iu
  • Heparin 10000 iu
  • Heparin 200 iu
  • Heparin Sodium 200 iu
  • Heparin 250 iu
  • Heparin 2500 iu
  • Heparin Sodium 25000 iu
  • Heparin 3000 iu
  • Heparin 3500 iu
  • Heparin 400 iu
  • Heparin 4000 iu
  • Heparin Sodium 50 iu
  • Heparin 50 iu
  • Heparin 5000 iu
  • Heparin 600 iu
  • Heparin 800 iu
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