Heparin Sod 1000u/ml Inj, 1ml
Overview
What is this medicine?
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and read all the information provided. It's essential to follow the dosage instructions carefully. This medication can be administered in different ways, including:
Through a catheter
As an injection into a vein
As an injection into the fatty part of the skin
As an infusion into a vein over a period of time
If you have any questions or concerns, be sure to discuss them with your doctor.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist for guidance on proper storage.
What to Do If You Miss a Dose
If you miss a dose, contact your doctor to determine the best course of action. They will advise you on what to do next.
Lifestyle & Tips
- Avoid activities that could cause injury or bleeding (e.g., contact sports, sharp objects).
- Use a soft toothbrush and an electric razor to minimize bleeding.
- Inform all healthcare providers, including dentists, that you are taking heparin.
- Report any signs of unusual bleeding or bruising immediately.
- Do not take over-the-counter pain relievers like aspirin or NSAIDs (e.g., ibuprofen, naproxen) without consulting your doctor, as they can increase bleeding risk.
Available Forms & Alternatives
Available Strengths:
- Heparin Lock Flush 100u/ml Inj, 1ml
- Heparin Lock Flush 100u/ml Inj, 5ml
- Heparin Sod 1000u/ml Inj, 2ml
- Heparin Sod 5,000u/ml Inj, 10ml
- Heparin Sod 5000u/0.5ml Inj, 0.5ml
- Heparin Sod 5,000u/ml Inj, 1ml
- Heparin Lock Flush 10u/ml Inj, 5ml
- Heparin Sod 1000u/ml Inj, 10ml
- Heparin Sod 1000u/ml Inj, 1ml
- Heparin Sod 10,000u/ml Inj, 4ml
- Heparin Sod 5000u/ml Carpuject, 1ml
- Heparin Lock Flush 100u/ml Inj, 3ml
- Heparin Sod 1000u/ml Inj, 30ml
- Heparin Sod 5000u/ml Prefilled Syr
- Heparin Sod 5000u/ml Inj, 1ml
- Heparin Lock Flush 10u/ml Inj, 1ml
- Heparin Sod 10,000u/ml Inj, 1ml
- Heparin Sod 20000u/ml Inj 1ml
- Heparin Sod 10,000u/ml Inj, 5ml
- Heparin Lock Flush 10u/ml Inj, 3ml
- Heparin Sod/nacl 25000u Inj, 500ml
- Heparin Sod/d5w 100u/ml Inj, 250ml
- Hep Sod/nacl 25000unt Inj, 250ml
- Heparin Na 50u/1ml/sod Cl 0.45% Inj
- Heparin Posiflush 100u/ml Inj, 3ml
- Heparin Sod 1000u/ml Inj,30ml
Dosing & Administration
Adult Dosing
Condition-Specific Dosing:
Pediatric Dosing
Dose Adjustments
Renal Impairment:
Hepatic Impairment:
Pharmacology
Mechanism of Action
Pharmacokinetics
Absorption:
Distribution:
Elimination:
Pharmacodynamics
Safety & Warnings
BLACK BOX WARNING
Side Effects
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of bleeding, including:
+ Vomiting or coughing up blood
+ Vomit that resembles coffee grounds
+ Blood in the urine
+ Black, red, or tarry stools
+ Bleeding from the gums
+ Abnormal vaginal bleeding
+ Unexplained bruises or bruises that enlarge
+ Uncontrollable bleeding
Neurological symptoms, such as:
+ Weakness on one side of the body
+ Difficulty speaking or thinking
+ Changes in balance
+ Drooping on one side of the face
+ Blurred vision
Confusion
Severe headache
Dizziness or fainting
Upset stomach or vomiting
Unusual burning sensations, particularly on the soles of the feet
Swelling, warmth, numbness, color changes, or pain in a leg or arm
Chest pain or pressure
Shortness of breath
Back pain
Groin or pelvic pain or swelling
Changes in skin color at the injection site
Skin breakdown at the site of administration
Fever or chills
Other Possible Side Effects
Like all medications, this drug can cause side effects. However, many people experience no side effects or only mild ones. If you encounter any side effects that bother you or persist, contact your doctor for guidance.
Please note that this list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Any unusual bleeding (e.g., nosebleeds, bleeding gums, blood in urine or stool, heavy menstrual bleeding)
- Excessive bruising or purple spots on the skin
- Severe headache or dizziness
- Unusual weakness or fatigue
- Red or dark brown urine
- Black, tarry, or bloody stools
- Severe pain or swelling in a joint or muscle
- Sudden shortness of breath or chest pain
- Signs of allergic reaction: rash, itching, hives, swelling of face/lips/tongue, difficulty breathing
Before Using This Medicine
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you are allergic to pork products, discuss this with your doctor.
* Certain health conditions, including:
+ Bleeding problems or a low platelet count.
+ A history of low platelet count caused by heparin or pentosan polysulfate.
This list is not exhaustive, and it is crucial to disclose all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues to your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing health conditions and other drugs. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
While on this medication, you may experience easier bleeding. To minimize the risk of injury, exercise caution and take preventive measures such as using a soft toothbrush and an electric razor.
This medication can cause severe and potentially life-threatening bleeding problems. Additionally, it may lead to a condition known as heparin-induced thrombocytopenia (HIT), which can progress to heparin-induced thrombocytopenia and thrombosis (HITTS). Both HIT and HITTS can be fatal or result in other serious complications, and may occur up to several weeks after discontinuing the medication. If you have any questions or concerns, consult your doctor. It is crucial to undergo blood tests as directed by your doctor and to discuss any concerns with them.
This medication may interfere with certain laboratory tests. Therefore, it is vital to inform all your healthcare providers and laboratory personnel that you are taking this medication.
In the event of a fall, injury, or head trauma, contact your doctor immediately, even if you feel fine.
Ensure that you have the correct product, as this medication is available in various containers and strengths. If you are unsure, consult your doctor or pharmacist.
If you have a sulfite allergy, discuss this with your doctor, as some products contain sulfites.
Individuals over 60 years old should exercise caution when using this medication, as they may be more susceptible to side effects.
Some products contain benzyl alcohol, which can cause serious side effects in newborns and infants, particularly when combined with other medications containing benzyl alcohol. If possible, avoid using products with benzyl alcohol in these age groups. Consult your doctor to determine if the product contains benzyl alcohol.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. It is necessary to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Excessive bleeding (e.g., nosebleeds, gum bleeding, hematuria, melena, ecchymoses, petechiae)
- Hypotension (low blood pressure)
- Tachycardia (rapid heart rate)
- Shock
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. The antidote for heparin overdose is protamine sulfate, which neutralizes heparin's anticoagulant effect. Dosage of protamine sulfate depends on the amount of heparin administered and the time elapsed since administration. Supportive care (e.g., blood transfusions) may also be necessary.
Drug Interactions
Major Interactions
- Other anticoagulants (e.g., warfarin, direct oral anticoagulants, LMWH): Increased risk of bleeding.
- Antiplatelet agents (e.g., aspirin, clopidogrel, NSAIDs): Increased risk of bleeding.
- Thrombolytic agents (e.g., alteplase, reteplase): Increased risk of bleeding.
- Nitroglycerin (IV): May decrease heparin's anticoagulant effect (monitor aPTT).
Moderate Interactions
- Cephalosporins (certain, e.g., cefoperazone, cefotetan): May increase bleeding risk due to vitamin K antagonism.
- Probenecid: May increase heparin levels.
- Digoxin: May decrease digoxin levels.
- Tetracyclines: May decrease heparin's anticoagulant effect.
Monitoring
Baseline Monitoring
Rationale: To assess baseline hemoglobin, hematocrit, and platelet count before initiating therapy and to monitor for bleeding or heparin-induced thrombocytopenia (HIT).
Timing: Prior to initiation
Rationale: To establish baseline coagulation status, though not used for dose adjustment at baseline.
Timing: Prior to initiation
Rationale: To assess baseline coagulation status, especially if transitioning from or to warfarin.
Timing: Prior to initiation
Rationale: To assess organ function, as severe impairment may alter bleeding risk or drug sensitivity.
Timing: Prior to initiation
Routine Monitoring
Frequency: Every 4-6 hours after initiation or dose change until therapeutic, then daily.
Target: Typically 1.5-2.5 times control or institution-specific therapeutic range (e.g., 60-80 seconds).
Action Threshold: Adjust infusion rate based on aPTT results according to institutional nomogram.
Frequency: Alternative to aPTT, especially in conditions affecting aPTT (e.g., lupus anticoagulant). Every 4-6 hours after initiation or dose change until therapeutic, then daily.
Target: 0.3-0.7 units/mL for therapeutic anticoagulation.
Action Threshold: Adjust infusion rate based on anti-Xa results according to institutional nomogram.
Frequency: Every 2-3 days from day 4 to day 14 of therapy, or until heparin is discontinued.
Target: >100,000/mm³ or no significant drop from baseline.
Action Threshold: If platelet count drops by >50% from baseline or falls below 100,000/mm³, consider Heparin-Induced Thrombocytopenia (HIT) and discontinue heparin immediately. Initiate alternative anticoagulant.
Frequency: Continuously
Target: Absence of new or worsening bleeding.
Action Threshold: Any signs of bleeding (e.g., hematuria, melena, epistaxis, bruising, significant drop in Hgb/Hct) require immediate assessment and potential dose reduction or discontinuation.
Symptom Monitoring
- Unusual bleeding or bruising (e.g., nosebleeds, gum bleeding, blood in urine or stool, excessive bruising)
- Petechiae (small red spots on skin)
- Headache, dizziness, or weakness (may indicate internal bleeding)
- Severe pain or swelling at injection sites (for SC administration)
- Signs of allergic reaction (rash, itching, hives, swelling, difficulty breathing)
- Signs of Heparin-Induced Thrombocytopenia (HIT) such as new or worsening thrombosis, skin lesions at injection sites, or acute systemic reactions after heparin administration.
Special Patient Groups
Pregnancy
Heparin is generally considered the anticoagulant of choice during pregnancy when anticoagulation is required, as it does not cross the placenta and therefore does not cause fetal anticoagulation or teratogenicity. However, it is classified as Pregnancy Category C due to potential maternal risks (e.g., osteoporosis, thrombocytopenia, bleeding).
Trimester-Specific Risks:
Lactation
Heparin is considered safe during breastfeeding. It is a large molecule and is not excreted into breast milk in clinically significant amounts. It is also poorly absorbed orally by the infant.
Pediatric Use
Dosing is weight-based and requires careful titration and monitoring due to higher heparin requirements per kg and increased variability in response compared to adults. Neonates and infants may require higher doses per kg due to higher antithrombin levels and faster clearance. Close monitoring of aPTT or anti-Xa levels is crucial.
Geriatric Use
No specific dose adjustment is typically required based on age alone. However, elderly patients may be more susceptible to bleeding complications due to age-related physiological changes (e.g., decreased renal function, increased capillary fragility, polypharmacy). Close monitoring of anticoagulant effect and bleeding is essential.
Clinical Information
Clinical Pearls
- Heparin is highly variable in its anticoagulant effect due to binding to plasma proteins and cells; therefore, close laboratory monitoring (aPTT or anti-Xa) is essential for therapeutic dosing.
- The primary serious adverse effect is bleeding. Protamine sulfate is the specific antidote.
- Heparin-induced thrombocytopenia (HIT) is a serious, immune-mediated complication that can lead to paradoxical thrombosis. Monitor platelet counts regularly.
- For subcutaneous administration, inject into the abdominal wall, thigh, or upper arm, rotating sites. Do not rub the injection site.
- Heparin can cause hyperkalemia, especially in patients with renal impairment or those taking potassium-sparing diuretics or ACE inhibitors.
- Heparin is generally preferred over warfarin for anticoagulation during pregnancy due to its inability to cross the placenta.
Alternative Therapies
- Low Molecular Weight Heparins (LMWH) (e.g., enoxaparin, dalteparin): Often preferred for prophylaxis and outpatient treatment due to more predictable pharmacokinetics and less frequent monitoring.
- Fondaparinux: Synthetic pentasaccharide, selective Factor Xa inhibitor.
- Direct Thrombin Inhibitors (DTIs) (e.g., dabigatran, argatroban, bivalirudin): Used for specific indications, including HIT.
- Direct Oral Anticoagulants (DOACs) (e.g., rivaroxaban, apixaban, edoxaban, dabigatran): Used for DVT/PE treatment and prevention, stroke prevention in AFib.
- Warfarin: Oral vitamin K antagonist, used for long-term anticoagulation.
Cost & Coverage
General Drug Facts
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. Instead, consult with your pharmacist to determine the best method for disposal, as some communities may have designated drug take-back programs.
Additionally, some medications may come with a separate patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, do not hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider for guidance.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide detailed information about the overdose, including the name of the medication, the amount taken, and the time it was taken, to ensure prompt and effective treatment.