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HEPARIN is a brand name for Heparin. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Treatment of deep vein thrombosis, pulmonary embolism, unstable angina pectoris and acute peripheral arterial occlusion. In extracorporeal circulation and haemodialysis.
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Treatment of deep vein thrombosis, pulmonary embolism, unstable angina pectoris, acute peripheral arterial occlusion Adults: Loading dose: 5,000 units intravenously (10,000 units may be required in severe pulmonary embolism) Maintenance: 1,000-2,000 units/hour by intravenous infusion, or 5,000-10,000 units 4-hourly by intravenous injection.
Elderly:
Dosage reduction may be advisable. 5 x midpoint of normal range or control value.
In extracorporeal circulation and haemodialysis Cardiopulmonary bypass:
Initially 300 units/kg intravenously, adjusted thereafter to maintain the activated clotting time (ACT) in the range 400-500 seconds Haemodialysis and haemofiltration: Loading dose: 1,000-5,000 units Maintenance: 1,000-2,000 units/hour, adjusted to maintain clotting time >40 minutes.
4). 9% sodium chloride or by intermittent intravenous injection. As the effects of heparin are short-lived, administration by intravenous infusion is preferable to intermittent intravenous injections. Heparin should not be administered by intramuscular injection.
9). 4). It has been reported that thrombocytopenia occurs more frequently with bovine-derived heparin than porcine-derived heparin. Two types of heparin-induced thrombocytopenia have been defined. Type I is frequent, mild (usually >50 x 109/L) and transient, occurring within 1-5 days of heparin administration.
Type II is less frequent but often associated with severe thrombocytopenia (usually <50 x 109/L). It is immune- mediated and occurs after a week or more (earlier in patients previously exposed to heparin). It is associated with the production of a platelet-aggregating antibody and thromboembolic complications, due to platelet-rich thrombi (the 'white clot syndrome'), which may precede the onset of thrombocytopenia.
Pulmonary embolism has been reported as thromboembolic complications of heparin-induced thrombocytopenia. Heparin should be discontinued immediately in patients who develop thrombocytopenia. Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia and thrombosis (HITT) can occur up to several weeks after the discontinuation of heparin therapy.
Patients presenting with thrombocytopenia or thrombosis after discontinuation of heparin should be evaluated for HIT and HITT. Immune system disorders Hypersensitivity reactions to heparin are rare They include urticaria, conjunctivitis, rhinitis, asthma, cyanosis, tachypnoea, feeling of oppression, fever, chills, angioneurotic oedema and anaphylactic shock.
Metabolism and nutrition disorders Heparin administration is associated with release of lipoprotein lipase into the plasma; rebound hyperlipidaemia may follow heparin withdrawal. Vascular disorders Haematoma. 4). Hepatobiliary disorders Increased serum transaminase values may occur but usually resolve on discontinuation of heparin.
Endocrine disorders Adrenal insufficiency secondary to adrenal haemorrhage has been associated with heparin (rarely). Heparin products can cause hypoaldosteronism which may result in an increase in plasma potassium. 4). Skin and subcutaneous tissue disorder Local irritation and skin necrosis may occur but are rare.
g. hiatus hernia, peptic ulcer, neoplasm, bacterial endocarditis, retinopathy, bleeding haemorrhoids, suspected intracranial haemorrhage, cerebral thrombosis or. Care should also be taken when heparin is administered to patients with hypertension, renal or hepatic insufficiency.
Platelet counts should be measured in patients receiving heparin treatment for longer than 5 days and the treatment should be stopped immediately in those who develop thrombocytopenia. Heparin induced thrombocytopenia (HIT) and heparin induced thrombocytopenia with thrombosis (HITT) can occur up to several weeks after discontinuation of heparin therapy.
Patients presenting with thrombocytopenia or thrombosis after discontinuation of heparin should be evaluated for HIT or HIT. In patients with advanced renal or hepatic disease, a reduction in dosage may be necessary. The risk of bleeding is increased with severe renal impairment and in the elderly (particularly elderly women).
U. in patients with a history of allergy. Heparin should be used with caution in patients with hypersensitivity to low molecular weight heparins. In most patients, the recommended low-dose regimen produces no alteration in clotting time.
However, patients show an individual response to heparin, and it is therefore essential that the effect of therapy on coagulation time should be monitored in patients undergoing major surgery. Caution is recommended in patients receiving heparin prophylactically and undergoing spinal or epidural anaesthesia or spinal puncture (risk of spinal or epidural haematoma resulting in prolonged or permanent paralysis).
The risk is increased by the use of a peridural or spinal catheter for anaesthesia, by the concomitant use of drugs affecting haemostasis such as non-steroidal anti- inflammatory drugs (NSAIDs), platelet inhibitors or anticoagulants and by traumatic or repeated puncture.
1. After major trauma, during surgery of the brain, spinal cord and eye, in procedures at sites where there is a risk of bleeding, in patients that have had recent surgery, and in patients undergoing lumbar puncture or regional anaesthetic block.
Patients who consume large amounts of alcohol, who have generalised or local haemorrhagic tendency, who are actively bleeding, have haemophilia or other bleeding disorders, including severe liver disease (including oesophageal varices), purpura, severe hypertension, active tuberculosis or increased capillary permeability.
Patients with present or previous thrombocytopenia. The rare occurrence of skin necrosis in patients receiving heparin contraindicates the further use of heparin either by subcutaneous or intravenous routes because of the risk of thrombocytopenia.
The relative risks and benefits of heparin should be carefully assessed in patients with a bleeding tendency or those patients with an actual or potential bleeding site eg. hiatus hernia, peptic ulcer, neoplasm, bacterial endocarditis, retinopathy, bleeding haemorrhoids, suspected intracranial haemorrhage, cerebral thrombosis or threatened abortion.
In patients receiving heparin for treatment rather than prophylaxis, locoregional anaesthesia in elective surgical procedures is contraindicated because use of heparin may be very rarely associated with epidural or spinal haematoma resulting in prolonged or permanent paralysis.
If such a procedure is planned the heparin should be stopped and the procedure should be delayed until the aPTT has returned to normal. 6). Threatened abortion. Menstruation is not a contra-indication. Concomitant use of intravenous diclofenac (including low dose heparin) is contraindicated.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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If this occurs treatment must be withdrawn immediately. e. over many months) may cause alopecia. e. over many months) may cause osteoporosis and fractures in the vertebra and ribs. U. per day of heparin for three months or longer. Reproductive system and breast disorders Priapism has been reported.
Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store .
In decision making on the interval between the last administration of heparin at prophylactic doses and the placement or removal of a peridural or spinal catheter, the product characteristics and the patient profile should be taken into account.
Subsequent dose should not take place before at least four hours have elapsed. Re- administration should be delayed until the surgical procedure is completed. In patients receiving heparin for treatment rather than prophylaxis, locoregional anaesthesia in elective surgical procedures is contra- indicated because the use of heparin may be very rarely associated with epidural or spinal haematoma resulting in prolonged or permanent paralysis.
If such a procedure is planned the heparin should be stopped and the procedure should be delayed until the aPTT has returned to normal. Should a physician decide to administer anti-coagulation in the context of peridural or spinal anaesthesia, extreme vigilance and frequent monitoring must be exercised to detect any signs and symptoms of neurologic impairment, such as back pain, sensory and motor deficits and bowel or bladder dysfunction.
Patients should be instructed to inform immediately a nurse or a clinician if they experience any of these. Heparin can suppress adrenal secretion of aldosterone leading to hyperkalaemia, particularly in patients such as those with diabetes mellitus, chronic renal failure, pre- existing metabolic acidosis, a raised plasma potassium, or taking potassium sparing drugs.
The risk of hyperkalaemia appears to increase with duration of therapy but is usually reversible. Plasma potassium should be measured in patients at risk before starting heparin therapy and in all patients treated for more than 7 days.
Due to increased bleeding risk, care should be taken when giving concomitant intramuscular injections, lumbar puncture and similar procedures. Heparin resistance There is considerable variation in individual anticoagulant responses to heparin.
Heparin resistance, defined as an inadequate response to heparin at a standard dose for achieving a therapeutic goal occurs in approximately 5 to 30% of patients. g. by aprotinin, oestrogen or possibly nitroglycerin) • Patients with normal or supranormal antithrombin III levels (antithrombin III-independent heparin resistance) ● Thromboembolic disorders ● Increased heparin clearance • Elevated levels of heparin binding proteins, factor VIII, von Willebrand factor, fibrinogen, platelet factor 4 or histidine- rich glycoprotein ● Active infection (sepsis or endocarditis) ● Preoperative intra-aortic balloon counterpulsation ● Thrombocytopenia ● Thrombocytosis ● Advanced age ● Plasma albumin concentration ≤ 35g/dl ● Relative hypovolaemia Heparin resistance is also often encountered in acutely ill patients, in patients with malignancy and during pregnancy or the post-partum period.
5). Excipients Heparin contains methyl- and propyl parahydroxybenzoate and sodium as excipients. Methyl- and propyl parahydroxybenzoate may cause allergic reactions (possibly delayed), and exceptionally, bronchospasm. Heparin sodium 1,000 IU/mL solution for injection or concentrate for solution for infusion This medicine contains less than 1 mmol sodium (23 mg) per vial, that is to say essentially […]