HEPARIN SODIUM 10,000 UNITS IN DEXTROSE 5% IN PLASTIC CONTAINER
Clinical safety rating: safe
Other drugs that affect hemostasis increase bleeding risk Can cause heparin-induced thrombocytopenia (HIT) and bleeding.
Heparin binds to antithrombin III, accelerating the inactivation of thrombin (factor IIa) and factor Xa, thereby inhibiting coagulation.
| Metabolism | Primarily metabolized by the liver via desulfation and depolymerization, with some uptake by the reticuloendothelial system; partially cleared by the kidneys. |
| Excretion | Primarily hepatic and reticuloendothelial system metabolism; renal excretion of metabolites accounts for <50% of clearance; minimal biliary/fecal elimination. |
| Half-life | Mean terminal half-life 1.5 hours (range 1-2 hours) at therapeutic doses; dose-dependent (nonlinear) due to saturable clearance; prolonged in renal impairment (up to 3-6 hours) and hepatic disease. |
| Protein binding | Very high; extensively binds to antithrombin III, heparin cofactor II, and other plasma proteins; >90% bound overall (albumin, lipoproteins, fibrinogen). |
| Volume of Distribution | 0.06-0.07 L/kg; primarily confined to intravascular space; minimal distribution to extravascular tissues due to high molecular weight and protein binding. |
| Bioavailability | Subcutaneous: approximately 30-50% (dose-dependent, saturable absorption). Intravenous: 100%. Not administered orally due to negligible bioavailability. |
| Onset of Action | Intravenous: immediate (within minutes). Subcutaneous: 20-30 minutes (therapeutic anticoagulation achieved by 1-2 hours). |
| Duration of Action | Intravenous: 2-6 hours (effects decline rapidly after cessation). Subcutaneous: 8-12 hours (dose-dependent); prolonged in renal impairment. |
| Molecular Weight | 15000 |
For therapeutic anticoagulation, administer intravenous bolus of 80 units/kg followed by continuous infusion at 18 units/kg/hour, adjusted to maintain aPTT 1.5-2.5 times control. For prophylaxis, 5,000 units subcutaneously every 8-12 hours.
| Dosage form | INJECTABLE |
| Renal impairment | Heparin is not renally eliminated; no dose adjustment required for renal impairment. However, caution in severe renal failure due to increased bleeding risk; monitor aPTT closely. |
| Liver impairment | No specific dose adjustment for hepatic impairment. However, patients with significant hepatic disease may have altered coagulation; monitor aPTT and bleeding complications closely. |
| Pediatric use | For therapeutic anticoagulation: intravenous bolus 75-100 units/kg, then continuous infusion 20 units/kg/hour, adjusted to target aPTT 1.5-2.5 times control. For prophylaxis: non-weight-based; typical subcutaneous dose 50-100 units/kg every 12 hours, not to exceed 5,000 units. |
| Geriatric use | Elderly patients may have increased sensitivity to heparin; consider lower initial doses (e.g., bolus 50 units/kg, infusion 15 units/kg/hour) and adjust based on aPTT. Monitor renal function and bleeding risk more frequently. |
| 1st trimester | Heparin does not cross the placenta and is not teratogenic; safe for use in first trimester for thromboembolism treatment or prophylaxis. |
| 2nd trimester | Safe; no increased risk of fetal malformations due to high molecular weight and inability to cross placenta. |
| 3rd trimester | Safe; monitor for maternal hemorrhage and thrombocytopenia. No fetal risk. |
Clinical note
Other drugs that affect hemostasis increase bleeding risk Can cause heparin-induced thrombocytopenia (HIT) and bleeding.
| FDA category | Human |
| Placental transfer | Heparin does not cross the placenta due to its large molecular size and negative charge. |
| Breastfeeding |
■ FDA Black Box Warning
Not recommended for use as a catheter lock solution due to risk of fatal hemorrhage in pediatric patients. Heparin is not intended for intramuscular use due to risk of hematoma.
| Common Effects | bleeding |
| Serious Effects |
Active major bleedingHistory of heparin-induced thrombocytopenia (HIT)Severe uncontrolled hypertensionKnown hypersensitivity to heparin or pork products
| Precautions | Risk of hemorrhage, especially in patients with bleeding disorders, recent surgery, or invasive procedures. Monitor coagulation parameters (aPTT). Risk of heparin-induced thrombocytopenia (HIT) and thrombosis (HITT). Use with caution in patients with renal impairment, hepatic disease, or advanced age. Avoid abrupt discontinuation; taper if possible. |
| Food/Dietary |
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| Heparin is not excreted into breast milk due to its high molecular weight and poor oral bioavailability; considered compatible with breastfeeding. |
| Lactation Rating | Safe |
| Teratogenic Risk | Heparin is a high-molecular-weight polysaccharide that does not cross the placenta. No fetal risk has been demonstrated in any trimester. It is classified as FDA Pregnancy Category C (historical) but is considered safe for use during pregnancy. |
| Fetal Monitoring | Maternal: Monitor platelet count (risk of heparin-induced thrombocytopenia), signs of bleeding (e.g., bruising, hematuria), and coagulation parameters (aPTT) as needed. Fetal: Routine prenatal care; no specific fetal monitoring required solely due to heparin use. |
| Fertility Effects | No known effects on fertility. Heparin does not interfere with ovulation, implantation, or spermatogenesis. |
| No significant food interactions. Avoid excessive alcohol consumption as it may increase bleeding risk. |
| Clinical Pearls | Monitor aPTT 6 hours after initiation or dose change, target 1.5-2.5 times control. Use with caution in renal impairment; consider dose adjustment. Discontinue prior to invasive procedures. Protamine sulfate is reversal agent. Do not administer IM due to hematoma risk. In D5W, monitor blood glucose in diabetics. |
| Patient Advice | Report any signs of bleeding such as bruising, dark stools, or blood in urine. · Avoid aspirin and NSAIDs unless prescribed by your doctor. · Use a soft toothbrush and electric razor to minimize bleeding risk. · Inform all healthcare providers you are on heparin. · Do not stop taking this medication suddenly without consulting your doctor. |