Composition
Inj: Heparinsodium/calcium 1000 units (1 ml)/5000 units (1 ml)/25000 units (1 ml)/10000units (2ml)/12500 units (0.5 ml)/20000units (0.8 ml)/7500 units (0.3 ml) amp/via pre-filled syringe. .
Indications & Dosage
Treatment of pulmonary embolism, unstable angina & acute peripheral arterial occlusion: BY IV INJ: Adult: Loading dose of 5000 units or 75 units/kg followed by continuous IV inj of 18 units/kg/hr.10000 units in severe pulmonary embolism, Treatment of deep-Vein thrombosis: BY IV OR SC INJ: Adult: Loading dose of 5000 units or 75 units/kg, followed by continuous IV inf of 18 units/kg/hr or by SC of 15000 units every 12 hrs. Thromboprophylaxis: BY SC INJ: Adult: In medical patients: 5000 units every 8-12 hrs. BY SC INJ: Adult: In surgical patients: 5000 units 2 hrs before surgery, then every 8-12 hrs. BY SC INJ: Adult: During pregnancy: 5000-10000 units every 12 hrs. Extracorporeal circulation and Haemodialysis: BY IV INJ: Adult: 1000-5000 units, followed by continuous IV INF of 250-1000 units/hr Children: Some preparations are licensed for use in children. Maintenance of neonatal umbilical arterial catheter: BY IV INF: Neonate: 0.5 units/hr Treatment of thrombotic episodes: BY IV INF: Neonate, 1 month-1 yr: Initially 75 units/kg (50 units/kg if under 35 wk corrected gestational age) by IV injection, then by continuous IV INF 25 units/kg/hr, adjusted according to APTT; 1-18 yrs: initially, 75 units/kg by IV injection, then by continuous IV INF 20units/kg/hr, adjusted according to APTT. BY SC INJ: 1 mth-18yrs: 250 units/kg twice daily, adjusted according to APTT Prophylaxis of thrombotic episodes: BY SC INJ: 1 mth-18yrs: 100units/kg (max 5000 units) twice daily, adjusted according to APTT. Prevention of clotting in extracorporeal circuits and Maintenance of cardiac shunts and critical stents: Consult product literature.
Administration
Infuse via infusion pump. Heparin lock: Inject via inj cap using positive pressure flushing technique. Heparin lock flush solution is intended only to maintain potency of IV devices & is not to be used for anticoagulant therapy. Administer SC injection into anterior abdominal wall, above the iliac crest & 5 cm or more away from the umbilicus. To minimize tissue trauma, fill adipose tissue away from deep tissues. Do not move needle while injecting drug & do not massage inj site before or after inj. Apply gentle pressure to the site after withdrawing needle. Use alternate inj sites. Standard diluent: 25000 units/500 ml D5W (premixed). Minimum volume: 250 ml D5W. For continuous inf, to prevent drug from pooling, invert container at least 6 times.
Compatibility
Stable in dextran 6% indextrose, dextran 6% in NS, D5LR, 05ANS, D5//NS, 025W, fat emulsion 10%, ANS, NS.
Contraindications
Haemorrhagic, diathesis, deficiency of coagulation factors, severe hepatic, renal or pancreatic impairment, severe thrombocytopenia, GI ulcers, hypertension, brain haemorrhage, COS injury or surgery, cerebral arterial aneurysm, retinopathy, vitreous haemorrhage, ophthalmic surgery, subacute bacterial endocarditis, imminent abortion, spinal or epidural anaesthesia, lumbar puncture, thrombocytopenia (type II) caused by heparin allergy, suspected malignant tumour with risk of bleeding, nephro- and ureterolithiasis, chronic alcohol abuse.
Precautions
Elderly, thrombocytopenia, organ punctures & angiography, cancer, post-surgical patients, advanced renal or hepatic disease, jaundice, neonates. Avoid IM inj
Interactions
Acetyl salicylic acid, coumarin derivatives, dux-Van,dipyridamole, NSAIDs, fibrinolytics, penicillin (high dose). IV nitroglycerin, propranolol, digitalis, tetracycline. nicotine, antihistamines.
Pregnancy
Caution advised; maternal osteoporosis reported after prolonged use
Lactation
May be used in breast feeding
Side Effects
Bleeding complications, transient alopecia, thrombocytopenia; osteoporosis (long-term therapy), febrileor allergic reactions, hypoaldosteronism, reaction at injection site.