LIQUAEMIN SODIUM

Clinical safety rating: caution

Comprehensive clinical and safety monograph for LIQUAEMIN SODIUM (LIQUAEMIN SODIUM).

How it works

Heparin binds to antithrombin III, accelerating the inactivation of thrombin and factor Xa, thereby inhibiting coagulation cascade.

What the body does with it

Metabolism	Primarily metabolized by the reticuloendothelial system; partially desulfated and depolymerized. Renal excretion of metabolites.
Excretion	Primarily renal (heparin is metabolized and excreted as uroheparin and other metabolites; up to 50% of administered dose appears in urine as unchanged heparin, but clearance is dose-dependent and nonlinear).
Half-life	Mean 1.5 hours (range 1-2 hours) after IV administration; increases with dose (e.g., 25,000 U IV: ~2.5 h). Clinical context: nonlinear pharmacokinetics; half-life prolonged in hepatic or renal impairment.
Protein binding	Very high; primarily binds to antithrombin III, fibrinogen, and other plasma proteins; fraction bound >90%.
Volume of Distribution	0.06-0.1 L/kg (confined to plasma volume; does not distribute widely due to high protein binding and polarity).
Bioavailability	SC: variable, ~30% (due to first-pass metabolism and binding; highly dependent on injection site and depth).
Onset of Action	IV: immediate; SC: 20-30 minutes (with therapeutic effect at 1-2 hours).
Duration of Action	IV: dose-dependent; single dose ~2-6 hours; SC: ~8-12 hours (clinical effect lasts 8-12 hours after a single SC dose).

Classification & Brands

Dosing & administration

Initial adult dose: 5,000 units IV bolus, followed by continuous IV infusion at 1,000–2,000 units/hour; or 10,000–20,000 units subcutaneously every 12 hours. Dose adjusted based on aPTT.

Dosage form	INJECTABLE
Renal impairment	GFR <30 mL/min: reduce dose by 25–50% and monitor aPTT closely. GFR 30–60 mL/min: consider dose reduction of 25%. Hemodialysis: avoid or use with extreme caution.
Liver impairment	Child-Pugh class B or C: dose reduction of 25–50% recommended due to increased risk of bleeding; monitor aPTT and anti-Xa levels.
Pediatric use	Neonates: 75 units/kg IV bolus, then 20 units/kg/hour. Infants and children: initial bolus 50–100 units/kg, maintenance 15–25 units/kg/hour continuous infusion; titrate to aPTT 1.5–2.5 times control.
Geriatric use	Elderly patients: initial dose reduction of 25–50% due to decreased renal function and higher bleeding risk; monitor aPTT and anti-Xa levels frequently.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for LIQUAEMIN SODIUM (LIQUAEMIN SODIUM).

Breastfeeding	Heparin is not excreted into breast milk due to high molecular weight and protein binding. Considered compatible with breastfeeding. M/P ratio: Not applicable (no transfer).
Teratogenic Risk	FDA Pregnancy Category B. Heparin does not cross the placenta and is not associated with teratogenicity. First trimester: No increased risk of major birth defects. Second/third trimester: Risk of maternal bleeding complications, fetal hemorrhage, and preterm labor. Use only if clearly needed.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Heparin is not intended for intramuscular use. Risk of spinal/epidural hematoma in patients receiving neuraxial anesthesia or spinal puncture, especially with concomitant use of agents affecting hemostasis.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to heparin; uncontrolled bleeding; history of HIT; severe thrombocytopenia; suspected intracranial hemorrhage; inability to perform adequate coagulation monitoring.

Clinical Precautions

Precautions

Risk of hemorrhage; heparin-induced thrombocytopenia (HIT); hypersensitivity reactions; hyperkalemia due to aldosterone suppression; osteoporosis with prolonged use; caution in renal/hepatic impairment, obesity, elderly; monitor platelet counts and aPTT.

Clinical Tips & Counseling

Drug interactions

Loading safety data…

LIQUAEMIN SODIUM

Clinical safety rating: caution

Comprehensive clinical and safety monograph for LIQUAEMIN SODIUM (LIQUAEMIN SODIUM).

How it works

Heparin binds to antithrombin III, accelerating the inactivation of thrombin and factor Xa, thereby inhibiting coagulation cascade.

What the body does with it

Metabolism	Primarily metabolized by the reticuloendothelial system; partially desulfated and depolymerized. Renal excretion of metabolites.
Excretion	Primarily renal (heparin is metabolized and excreted as uroheparin and other metabolites; up to 50% of administered dose appears in urine as unchanged heparin, but clearance is dose-dependent and nonlinear).
Half-life	Mean 1.5 hours (range 1-2 hours) after IV administration; increases with dose (e.g., 25,000 U IV: ~2.5 h). Clinical context: nonlinear pharmacokinetics; half-life prolonged in hepatic or renal impairment.
Protein binding	Very high; primarily binds to antithrombin III, fibrinogen, and other plasma proteins; fraction bound >90%.
Volume of Distribution	0.06-0.1 L/kg (confined to plasma volume; does not distribute widely due to high protein binding and polarity).
Bioavailability	SC: variable, ~30% (due to first-pass metabolism and binding; highly dependent on injection site and depth).
Onset of Action	IV: immediate; SC: 20-30 minutes (with therapeutic effect at 1-2 hours).
Duration of Action	IV: dose-dependent; single dose ~2-6 hours; SC: ~8-12 hours (clinical effect lasts 8-12 hours after a single SC dose).

Classification & Brands

Dosing & administration

Initial adult dose: 5,000 units IV bolus, followed by continuous IV infusion at 1,000–2,000 units/hour; or 10,000–20,000 units subcutaneously every 12 hours. Dose adjusted based on aPTT.

Dosage form	INJECTABLE
Renal impairment	GFR <30 mL/min: reduce dose by 25–50% and monitor aPTT closely. GFR 30–60 mL/min: consider dose reduction of 25%. Hemodialysis: avoid or use with extreme caution.
Liver impairment	Child-Pugh class B or C: dose reduction of 25–50% recommended due to increased risk of bleeding; monitor aPTT and anti-Xa levels.
Pediatric use	Neonates: 75 units/kg IV bolus, then 20 units/kg/hour. Infants and children: initial bolus 50–100 units/kg, maintenance 15–25 units/kg/hour continuous infusion; titrate to aPTT 1.5–2.5 times control.
Geriatric use	Elderly patients: initial dose reduction of 25–50% due to decreased renal function and higher bleeding risk; monitor aPTT and anti-Xa levels frequently.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for LIQUAEMIN SODIUM (LIQUAEMIN SODIUM).

Breastfeeding	Heparin is not excreted into breast milk due to high molecular weight and protein binding. Considered compatible with breastfeeding. M/P ratio: Not applicable (no transfer).
Teratogenic Risk	FDA Pregnancy Category B. Heparin does not cross the placenta and is not associated with teratogenicity. First trimester: No increased risk of major birth defects. Second/third trimester: Risk of maternal bleeding complications, fetal hemorrhage, and preterm labor. Use only if clearly needed.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to heparin; uncontrolled bleeding; history of HIT; severe thrombocytopenia; suspected intracranial hemorrhage; inability to perform adequate coagulation monitoring.