heparin

CLINICAL USE

Anticoagulant

DOSE IN NORMAL RENAL FUNCTION

Treatment of deep vein thrombosis and pulmonary embolism:IV: Loading dose: 5000–10 000 units —then a continuous intravenous infusion of 18 units/kg/hourTreatment of deep vein thrombosis: SC: 15 000 units every 12 hours, dose —is adjusted according to laboratory monitoringProphylaxis: 5000 units every 8–12 hours or according to local protocols

PHARMACOKINETICS

Molecular weight :3000–40 000

%Protein binding :>90

%Excreted unchanged in urine : 0 (up to 50% after large doses)

Volume of distribution (L/kg) :0.06–0.1

half-life – normal/ESRD (hrs) :1–6/Slightly prolonged (half-life increases with dose)

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Not dialysed. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of bleeding with NSAIDs – avoid concomitant use with IV diclofenac; increased risk of haemorrhage with ketorolac – avoid concomitant use

Nitrates: anticoagulant effect reduced by infusions of glyceryl trinitrateDrotrecogin alfa: manufacturer advises to avoid use of high doses of heparin with drotrecogin alfaUse with care in patients receiving oral anticoagulants, platelet aggregation inhibitors, aspirin or dextran

ADMINISTRATION

Reconstition

–

Route

IV infusion

or bolus, SC

Rate of Administration

18 units/kg/hour, or according to local protocol

Comments

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OTHER INFORMATION

Half-life is slightly prolonged in haemodialysis patients after intravenous administrationAlso used for the maintenance of extracorporeal circuits in cardiopulmonary bypass and haemodialysis1 mg protamine is required to neutralise 100 IU heparin; give slowly over 10 minutes, and do not exceed a total dose of 50 mgTo reduce or prevent fibrin formation in patients on PD, heparin may be added to PD fluid at a concentration of 1000 IU/L.

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