HEPARIN SODIUM 5,000 UNITS IN SODIUM CHLORIDE 0.9% IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Heparin binds to antithrombin III, enhancing its ability to inactivate thrombin, factor Xa, and other serine proteases involved in blood coagulation.
| Metabolism | Heparin is primarily metabolized in the liver and reticuloendothelial system, with some renal clearance. It is not metabolized by cytochrome P450 enzymes. |
| Excretion | Renal: negligible; primarily cleared by hepatic reticuloendothelial system and vascular endothelium via desulfation and depolymerization. No significant biliary or fecal elimination. |
| Half-life | Intravenous: 0.5–2.5 hours (dose-dependent); at therapeutic doses ~1.5 hours. Prolonged in hepatic or renal impairment. |
| Protein binding | Extensive (~95%) to antithrombin III, fibrinogen, lipoproteins, and other plasma proteins. |
| Volume of Distribution | 0.06–0.1 L/kg (low, consistent with plasma volume). Does not cross placenta or blood-brain barrier. |
| Bioavailability | Subcutaneous: 20–30% (due to high protein binding and degradation). Not administered orally. |
| Onset of Action | Intravenous: immediate (within seconds). Subcutaneous: 20–60 minutes. |
| Duration of Action | Intravenous: 2–6 hours (dose-dependent). Subcutaneous: 8–12 hours (with 12-hour dosing interval). |
| Molecular Weight | 15000 |
5000 units IV bolus followed by continuous IV infusion of 1300 units/hour, adjusted to maintain aPTT of 1.5-2.5 times control.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment recommended for GFR >30 mL/min. For GFR 15-30 mL/min: reduce infusion rate by 20%. For GFR <15 mL/min: reduce infusion rate by 50%. |
| Liver impairment | No specific Child-Pugh based guidelines. Use with caution in severe hepatic impairment; consider reduced doses due to decreased antithrombin III synthesis and potential for increased bleeding risk. |
| Pediatric use | Initial IV bolus of 75-100 units/kg, followed by continuous infusion of 15-25 units/kg/hour, adjusted to achieve aPTT of 60-85 seconds. |
| Geriatric use | Reduce initial bolus to 50 units/kg and continuous infusion to 10-20 units/kg/hour. Monitor aPTT closely; lower doses often required due to decreased drug clearance and increased bleeding risk. |
| 1st trimester | Heparin does not cross the placenta due to high molecular weight and is not associated with teratogenic risk in human studies. Use if clinically indicated. |
| 2nd trimester | No increased risk of fetal anomalies has been reported. Heparin is preferred for anticoagulation during pregnancy as it does not cross the placenta. |
| 3rd trimester | Use with caution near term due to risk of maternal hemorrhage and epidural hematoma with neuraxial anesthesia. No fetal risk. |
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 (approximately 12,000-15,000 Da) and negative charge. |
| Breastfeeding | Heparin is not excreted into breast milk due to its high molecular weight and polarity. It is considered safe during breastfeeding. Monitor infant for signs of bleeding if mother is on high doses, though risk is minimal. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Heparin is a large molecule that does not cross the placenta; thus, it is not associated with teratogenicity or fetal bleeding. No increased risk of congenital anomalies has been reported in any trimester. |
| Fetal Monitoring | Monitoring of activated partial thromboplastin time (aPTT) for dose adjustment; platelet count for heparin-induced thrombocytopenia; signs of bleeding or thrombosis; fetal surveillance (ultrasound for growth and amniotic fluid) if used for high-risk pregnancy conditions. |
| Fertility Effects | No known adverse effects on fertility. Heparin may be used in assisted reproductive technology for thromboprophylaxis without impairing implantation or pregnancy rates. |
■ FDA Black Box Warning
Heparin can cause heparin-induced thrombocytopenia (HIT) with or without thrombosis. Monitor platelets closely.
| Common Effects | fluid replacement |
| Serious Effects |
Severe thrombocytopenia (heparin-induced thrombocytopenia, HIT) or history of HITActive major bleeding or hemorrhagic disordersHypersensitivity to heparin or pork productsUncontrolled severe hypertensionRecent surgery or trauma with high bleeding riskEpidural or spinal anesthesia (risk of spinal hematoma)
| Precautions | Risk of heparin-induced thrombocytopenia (HIT), Risk of bleeding, especially in patients with renal impairment or on antiplatelet therapy, Monitor coagulation parameters (aPTT), Use with caution in patients with history of HIT, recent surgery, or active bleeding |
| Food/Dietary | No significant food interactions. However, avoid excessive consumption of foods high in vitamin K (e.g., leafy greens) if on concurrent warfarin therapy, as heparin alone does not interact with vitamin K. |
| Clinical Pearls | Heparin 5,000 units in 0.9% NaCl is typically used for venous thromboembolism prophylaxis. Monitor aPTT if using therapeutic dosing; for prophylactic doses, aPTT monitoring is usually not required. Use with caution in patients with renal impairment or history of HIT. Administer via IV infusion; do not mix with other drugs. Check platelet counts regularly to monitor for heparin-induced thrombocytopenia (HIT). |
| Patient Advice | This medication is used to prevent blood clots. You will receive it as an infusion into your vein. · Report any signs of unusual bleeding or bruising, such as blood in urine/stool, coughing up blood, or nosebleeds. · Inform all healthcare providers that you are on heparin, especially before any surgery or dental procedures. · Do not take aspirin, ibuprofen, or other NSAIDs without consulting your doctor, as they may increase bleeding risk. · If you develop a rash, fever, or chills, notify your healthcare provider immediately. |
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