HEPARIN SODIUM 5,000 UNITS IN SODIUM CHLORIDE 0.9% IN PLASTIC CONTAINER
Clinical safety rating: safe
No 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). |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Heparin is not excreted into breast milk due to its high molecular weight and acidic nature. It is considered compatible with breastfeeding. M/P ratio is not available because milk concentrations are undetectable. |
| 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. |
■ FDA Black Box Warning
Heparin can cause heparin-induced thrombocytopenia (HIT) with or without thrombosis. Monitor platelets closely.
| Common Effects | fluid replacement |
| Serious Effects |
["History of heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia and thrombosis (HITTS)","Active major bleeding or bleeding disorders","Severe thrombocytopenia","Hypersensitivity to heparin or any component"]
| 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"] |
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| 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. |