HEPARIN SODIUM 25,000 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, causing a conformational change that accelerates the inactivation of thrombin (factor IIa) and factor Xa. This inhibits fibrin formation and prevents clot propagation. Dextrose 5% provides a source of calories and fluid.
| Metabolism | Heparin is partially metabolized by the liver (via heparinase) and the reticular endothelial system to inactive metabolites (uroheparin). Desulfation and depolymerization occur. Renal excretion of metabolites. |
| Excretion | Renal: 40-50% as unchanged heparin (saturable); reticuloendothelial system: partial metabolism to uroheparin (less active); fecal: minimal (<5%). |
| Half-life | Terminal elimination half-life: 1-2 hours (dose-dependent, prolonged with higher doses due to saturable clearance). In hepatic or renal impairment: 1.5-3 hours. Clinical context: Twice-daily dosing may not maintain therapeutic levels; monitoring aPTT is essential. |
| Protein binding | 80-90% bound primarily to antithrombin III, with additional binding to albumin and other plasma proteins. |
| Volume of Distribution | 0.05-0.1 L/kg (confined to plasma volume; does not distribute into extravascular spaces). Clinical meaning: Indicates minimal tissue distribution; heparin acts in the intravascular compartment. |
| Bioavailability | Subcutaneous: 20-30% (due to limited absorption at injection site and binding to macrophages); Intravenous: 100%. |
| Onset of Action | Intravenous: immediate (within minutes); Subcutaneous: 20-30 minutes (delayed due to depot absorption). |
| Duration of Action | Intravenous: 2-6 hours (dose-dependent; continuous infusion required for sustained effect); Subcutaneous: 8-12 hours (low-dose prophylaxis). Note: Effects persist up to 2-4 hours after discontinuation of IV infusion. |
For therapeutic anticoagulation in adults, heparin is administered intravenously as an initial bolus of 80 units/kg followed by a continuous infusion of 18 units/kg/hour, with dose adjustment based on activated partial thromboplastin time (aPTT) targeting 1.5-2.5 times control. The concentration of heparin sodium 25,000 units and dextrose 5% in plastic container is typically used for continuous infusion at a rate calculated to deliver the prescribed units per hour.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment for renal impairment is required as heparin is not significantly renally excreted. However, caution is advised in severe renal impairment (GFR <30 mL/min) due to potential for accumulation and increased bleeding risk; monitoring of aPTT is essential. |
| Liver impairment | In hepatic impairment, heparin clearance may be reduced due to decreased production of antithrombin III and altered coagulation factors. For Child-Pugh Class A: no adjustment, but monitor aPTT closely. For Child-Pugh Class B or C: consider dose reduction (e.g., 25-50% reduction in bolus and infusion rates) and frequent aPTT monitoring to avoid excessive anticoagulation. |
| Pediatric use | For pediatric patients, heparin is administered intravenously as an initial bolus of 75 units/kg (range 50-100 units/kg) followed by a continuous infusion: infants (age <1 year): 28 units/kg/hour; children (age >1 year): 20 units/kg/hour. Dose titrated to achieve aPTT of 60-85 seconds (or heparin level of 0.3-0.7 units/mL anti-Xa). Concentration of 25,000 units in 500 mL D5W (50 units/mL) is used; infusion rate (mL/hour) = (dose in units/kg/hour × weight in kg) / 50 units/mL. |
| 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 polarity, making it compatible with breastfeeding. M/P ratio: not applicable (no detectable levels). |
| Teratogenic Risk | Heparin does not cross the placenta, thus is not associated with teratogenicity. No fetal risk in first trimester. In second/third trimester, use is safe but risk of maternal hemorrhage and fetal bleeding if coagulation abnormalities occur. |
■ FDA Black Box Warning
Heparin-induced thrombocytopenia (HIT) with thrombosis; monitor platelet counts closely. Spinal/epidural hematomas can occur with neuraxial anesthesia or spinal puncture, especially with concomitant use of other anticoagulants or antiplatelet drugs, leading to permanent paralysis.
| Common Effects | bleeding |
| Serious Effects |
["History of heparin-induced thrombocytopenia (HIT) or HIT with thrombosis","Active major bleeding (except when heparin is used for DIC or massive PE)","Severe thrombocytopenia","Inability to perform adequate coagulation monitoring","Hypersensitivity to heparin or pork products","Contraindicated for IM administration (risk of hematoma)"]
| Precautions | ["Heparin-induced thrombocytopenia (HIT) risk: monitor platelets every 2-3 days","Hemorrhage risk: caution with bleeding disorders, recent surgery, or concurrent anticoagulants","Hypersensitivity reactions (chills, fever, urticaria)","Osteoporosis with prolonged use (>1 month)","Hyperkalemia due to aldosterone suppression (especially in renal failure, diabetes)","Priapism (rare)"] |
Loading safety data…
| Geriatric use | Elderly patients (age >65 years) are at increased risk of bleeding. Lower initial doses are recommended: consider reducing bolus to 50 units/kg and infusion to 15 units/kg/hour, with careful titration based on aPTT. Monitor renal function (creatinine clearance) as age-related decline may affect heparin clearance despite minimal renal excretion; also monitor for signs of bleeding more frequently. |
| Fetal Monitoring | Monitor maternal platelet count (risk of heparin-induced thrombocytopenia), coagulation parameters (aPTT, anti-Xa), signs of hemorrhage, and fetal surveillance (ultrasound growth, non-stress test) if used for extended periods in pregnancy. |
| Fertility Effects | No evidence of adverse effects on fertility. Heparin does not impair spermatogenesis or oogenesis. No impact on conception or implantation. |