HEPARIN SODIUM 2,000 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 its inhibition of coagulation factors IIa (thrombin), Xa, and others, thereby preventing thrombus formation and extension.
| Metabolism | Heparin is metabolized in the liver and reticuloendothelial system by desulfation and depolymerization; also cleared renally. |
| Excretion | Primarily renal (40-60% as unchanged drug) and reticuloendothelial system; small amount biliary/fecal. Clearance is saturable. |
| Half-life | 30-150 minutes (dose-dependent, saturable); mean 60-90 min. Prolonged in hepatic/renal impairment and pulmonary embolism. |
| Protein binding | High, >90% primarily to antithrombin III, also albumin and other proteins. |
| Volume of Distribution | 0.05-0.07 L/kg (limited to plasma volume); increased in pregnancy and hyperlipidemia. |
| Bioavailability | SC: 20-40% (dose-dependent due to saturable absorption); IV: 100%. |
| Onset of Action | IV: immediate; SC: 20-30 minutes. |
| Duration of Action | IV: 2-6 hours (dose-dependent); SC: 8-12 hours. Longer duration in renal impairment. |
25,000 units in 250 mL D5W (100 units/mL) continuous IV infusion at 20,000-40,000 units/24 hours; adjust based on aPTT.
| Dosage form | INJECTABLE |
| Renal impairment | No specific GFR-based dose adjustment required; caution in severe renal impairment (CrCl <30 mL/min) due to increased bleeding risk. |
| Liver impairment | Contraindicated in severe hepatic disease (Child-Pugh class C) due to profound coagulation defects; use with caution in moderate impairment (Child-Pugh class B) with reduced doses. |
| Pediatric use | Initial IV bolus 50-100 units/kg, followed by continuous IV infusion of 15-25 units/kg/hour; titrate to target aPTT. |
| Geriatric use | Reduce infusion rate by 30-50% due to increased sensitivity and reduced clearance; monitor aPTT closely to avoid bleeding. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Other drugs that affect hemostasis increase bleeding risk Can cause heparin-induced thrombocytopenia (HIT) and bleeding.
| FDA category | Human |
| Breastfeeding | Heparin is not excreted into breast milk due to high molecular weight and poor oral bioavailability; considered compatible with breastfeeding. No M/P ratio available. |
| Teratogenic Risk | FDA Pregnancy Category C. Heparin does not cross the placenta; no teratogenic effects reported. Risk of maternal hemorrhage and fetal bleeding during delivery. Use only if clearly needed. |
■ FDA Black Box Warning
Heparin should not be given intramuscularly due to risk of hematoma. Increased risk of bleeding, including fatal hemorrhagic events. Monitor platelets closely for heparin-induced thrombocytopenia (HIT). Heparin is not recommended for use as an anticoagulant in pregnant women with prosthetic heart valves due to risk of maternal thromboembolism.
| Common Effects | bleeding |
| Serious Effects |
["Hypersensitivity to heparin or pork products","History of heparin-induced thrombocytopenia","Active major bleeding or bleeding disorders (e.g., hemophilia, thrombocytopenia)","Patients undergoing regional anesthesia (e.g., spinal/epidural) unless in low-dose prophylaxis"]
| Precautions | ["Risk of bleeding, especially in patients with hemorrhagic conditions, recent surgery, or concurrent use of antiplatelet agents/anticoagulants","Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT)","Hyperkalemia due to suppression of aldosterone synthesis","Osteoporosis with long-term use","Hypersensitivity reactions","Benzyl alcohol preservative risk in neonates"] |
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| Fetal Monitoring | Monitor aPTT, platelet counts, signs of bleeding, and heparin-induced thrombocytopenia. Fetal monitoring for heart rate and growth if used long-term. |
| Fertility Effects | No known adverse effects on fertility in males or females. |