HEPARIN SODIUM 5,000 UNITS IN SODIUM CHLORIDE 0.9%
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Heparin binds to antithrombin III, accelerating its inactivation of thrombin (factor IIa) and factor Xa, thereby inhibiting coagulation.
| Metabolism | Heparin undergoes desulfation and partial depolymerization in the liver and reticuloendothelial system; primarily cleared by the kidneys. |
| Excretion | Renal: 40% as unchanged drug; reticuloendothelial system (liver, spleen): 60% metabolized to low molecular weight forms, then renally eliminated. |
| Half-life | Terminal half-life: 1-2 hours (dose-dependent; mean 1.5 hours). Clinical context: Prolonged in hepatic/renal insufficiency; obesity (increased Vd). IV bolus: 30-60 min; continuous infusion: 1-2 hours. |
| Protein binding | High, >95% bound to antithrombin III, albumin, and other plasma proteins. |
| Volume of Distribution | 0.04-0.06 L/kg (confined to plasma; does not cross placenta). Clinical meaning: Low Vd reflects limited extravascular distribution; predominantly intravascular. |
| Bioavailability | SC: 20-30% (due to first-pass hepatic metabolism and local inactivation). |
| Onset of Action | IV: immediate (within minutes); SC: 20-30 minutes (therapeutic APTT at 1-2 hours). |
| Duration of Action | IV: 2-6 hours (dose-dependent); SC: 8-12 hours (with 5,000 units). Clinical notes: Effect monitored via APTT; neutralized by protamine sulfate. |
| Molecular Weight | 15000 |
5,000 units IV bolus, followed by continuous IV infusion of 18 units/kg/hr (initial based on actual body weight) for treatment of venous thromboembolism; or 5,000 units subcutaneously every 8-12 hours for prophylaxis of deep vein thrombosis. Titrate to aPTT 1.5-2.5 times control.
| Dosage form | INJECTABLE |
| Renal impairment | No standard dose adjustment for GFR; however, close monitoring of aPTT and for bleeding is recommended in severe renal impairment (CrCl <30 mL/min) due to increased risk of accumulation. |
| Liver impairment | No specific dose adjustment based on Child-Pugh class; use with caution in hepatic disease due to decreased clearance and increased risk of bleeding. Monitor aPTT and clinical response. |
| Pediatric use | Loading dose: 75-100 units/kg IV over 10 minutes. Maintenance infusion: For age ≤1 year: 28 units/kg/hr; age >1 year: 20 units/kg/hr; adjust to achieve aPTT of 60-85 seconds or anti-Xa level of 0.3-0.7 units/mL. |
| Geriatric use | Increased risk of bleeding; consider lower initial infusion rates (e.g., 12-15 units/kg/hr) and more frequent aPTT monitoring. Use caution due to age-related renal function decline and concurrent medications. |
| 1st trimester | Heparin does not cross the placenta; no evidence of teratogenicity in humans. |
| 2nd trimester | Safe; monitor for bleeding and thrombocytopenia. |
| 3rd trimester | Safe; increased risk of bleeding during delivery. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| 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 ionic charge; considered compatible with breastfeeding. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Heparin does not cross the placenta; no known teratogenic risk. First trimester: No increased risk of major malformations. Second/third trimesters: Risk of maternal hemorrhage, placental abruption, or preterm labor if anticoagulation is excessive. No direct fetal toxicity. |
| Fetal Monitoring | Monitor activated partial thromboplastin time (aPTT) to maintain therapeutic range (1.5-2.5 times control). Platelet count for heparin-induced thrombocytopenia. Fetal surveillance via ultrasound for growth and well-being if long-term use. Monitor for signs of bleeding (maternal and fetal). |
| Fertility Effects | Heparin does not impair fertility in animal studies. No human data suggest adverse effects on fertility. Indirect effects possible only through underlying disease (e.g., antiphospholipid syndrome). |
■ FDA Black Box Warning
Spinal or epidural hematomas, including subsequent paralysis, may occur in patients anticoagulated with heparin who receive neuraxial anesthesia or undergo spinal puncture. Risk is increased by indwelling epidural catheters, concomitant use of drugs affecting hemostasis (e.g., NSAIDs, platelet inhibitors, anticoagulants), traumatic or repeated puncture. Monitor for signs/symptoms of neurological impairment.
| Common Effects | fluid replacement |
| 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 concurrent use of antiplatelet agents or anticoagulants. Monitor platelet counts for heparin-induced thrombocytopenia (HIT). May cause hyperkalemia by suppressing aldosterone secretion. Use with caution in hepatic or renal impairment. Avoid intramuscular injection. |
| Food/Dietary | No significant food interactions. Heparin is administered parenterally and does not interact with dietary components. Vitamin K-rich foods (e.g., leafy greens) do not affect heparin activity. |
| Clinical Pearls | Heparin flushes (5000 U/mL) are used for catheter patency only; do not use therapeutic dosing. Verify concentration before administration. Flush volume should match catheter lumen volume. Monitor for bleeding risk in patients with thrombocytopenia or coagulation disorders. Use preservative-free formulation in neonates. |
| Patient Advice | This medication is used to keep your IV line or catheter from clotting. · It contains heparin and will be given by a healthcare professional. · Tell your doctor if you have a history of heparin-induced thrombocytopenia (HIT) or if you take blood thinners like warfarin. · Report any unusual bleeding, bruising, or pain at the IV site immediately. · You may need regular blood tests to monitor your platelet count. |
Loading safety data…