HEPARIN SODIUM 20,000 UNITS AND 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 thrombin (factor IIa) and activated factor X (Xa), thereby preventing fibrin formation. Dextrose 5% provides caloric support.
| Metabolism | Primarily metabolized in the liver and reticuloendothelial system via desulfation and depolymerization; partially cleared by the kidneys. |
| Excretion | Renal: negligible at therapeutic doses; hepatic metabolism to uroheparin and low molecular weight species; biliary/fecal: minimal. Clearance is dose-dependent and saturable. |
| Half-life | 30–150 minutes (mean 90 min) for continuous IV infusion; shorter with higher doses due to saturable clearance. Prolonged in hepatic or renal impairment. |
| Protein binding | >90% bound to antithrombin III, albumin, fibrinogen, and other plasma proteins. |
| Volume of Distribution | 0.05–0.1 L/kg (confined to plasma volume); larger in obesity due to increased plasma volume. |
| Bioavailability | SC: approximately 30% (variable, dose-dependent). IV: 100%. |
| Onset of Action | IV: immediate (within minutes); Subcutaneous: 20–60 minutes. |
| Duration of Action | IV: 2–6 hours (dose-dependent); SC: 8–12 hours. Disappears from blood within 4–6 hours after IV bolus. |
| Molecular Weight | 15000 |
IV: Initial bolus 80 units/kg, then continuous infusion at 18 units/kg/hr; adjust based on aPTT. Typical concentration: 20,000 units heparin in 500 mL D5W (40 units/mL).
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment required for heparin; however, consider increased risk of bleeding in severe renal impairment (CrCl <30 mL/min). Monitor aPTT closely. |
| Liver impairment | In hepatic impairment (Child-Pugh class B or C), increased sensitivity to heparin due to reduced antithrombin III and impaired clearance; reduce initial dose by 30-50% and monitor aPTT carefully. |
| Pediatric use | IV: Bolus 75-100 units/kg, then maintenance: infants: 28 units/kg/hr; children: 20 units/kg/hr; adolescents: 18 units/kg/hr. Adjust to target aPTT of 60-85 seconds (or institutional range). |
| Geriatric use | Elderly patients may have altered pharmacodynamics and increased risk of bleeding; consider lower initial bolus (e.g., 50-60 units/kg) and infusion rate (e.g., 15 units/kg/hr). Titrate based on aPTT and clinical response. |
| 1st trimester | Heparin does not cross the placenta; considered safe in pregnancy. No teratogenic effects documented. |
| 2nd trimester | Safe to use; no increased fetal risk. |
| 3rd trimester | Safe to use; caution for maternal hemorrhage risk during delivery. |
Clinical note
Other drugs that affect hemostasis increase bleeding risk Can cause heparin-induced thrombocytopenia (HIT) and bleeding.
| FDA category | Human |
| Placental transfer | Does not cross the placenta due to high molecular weight and negative charge. |
| Breastfeeding | Heparin is not excreted into breast milk due to high molecular weight and ionization; considered compatible with breastfeeding. |
■ FDA Black Box Warning
Heparin-induced thrombocytopenia (HIT) may occur with monitoring required. Hemorrhage risk; use cautiously in patients with increased bleeding risk.
| Common Effects | bleeding |
| Serious Effects |
Severe thrombocytopenia (e.g., heparin-induced thrombocytopenia)Uncontrolled active bleeding (except when due to disseminated intravascular coagulation)Known hypersensitivity to heparinMajor surgery or trauma with active bleedingHistory of heparin-induced thrombocytopenia
| Precautions | Monitor platelet counts for HIT and HIT with thrombosis (HITT)., Risk of major hemorrhage, especially when combined with antiplatelet agents or other anticoagulants., Use with caution in patients with severe hypertension, recent surgery, or gastrointestinal bleeding., Heparin resistance may occur with antithrombin III deficiency., Protamine sulfate used for reversal of heparin; hypersensitivity reactions to heparin possible. |
Loading safety data…
| Lactation Rating | L1 - Safest |
| Teratogenic Risk | Heparin does not cross the placenta and is not associated with teratogenicity. No fetal risk in first trimester. In second and third trimesters, risk of maternal bleeding or placental abruption with overdosage. Dextrose 5% provides calories and may cause maternal hyperglycemia affecting fetal insulin production. |
| Fetal Monitoring | Monitor maternal aPTT every 6 hours during therapy. Platelet count every 2-3 days for heparin-induced thrombocytopenia. Fetal heart rate monitoring during labor if used for thromboembolism. Maternal blood glucose monitoring if dextrose load is significant. |
| Fertility Effects | No known adverse effects on fertility. Heparin does not affect gametogenesis or implantation. |
| Food/Dietary |
| No specific food interactions. Avoid excessive consumption of vitamin K-rich foods (e.g., leafy greens) if transitioning to warfarin. Dextrose content may affect blood glucose. |
| Clinical Pearls | Heparin acts by activating antithrombin III. Monitor aPTT 6 hours after dose change; target 1.5-2.5 times control. Use with caution in renal impairment. Do not use as a flush solution in heparin-induced thrombocytopenia (HIT). Check platelet counts frequently. Reversal: protamine sulfate (1 mg per 100 units heparin). Note dextrose content in diabetic patients. |
| Patient Advice | You will receive blood tests (aPTT) to monitor drug levels. · Report any unusual bleeding, bruising, or dark stools immediately. · Avoid aspirin and NSAIDs unless prescribed by your doctor. · Inform all healthcare providers you are on heparin. · This medication contains dextrose; if you have diabetes, blood sugar monitoring may be needed. |