heparin (Rx)

Brand and Other Names:
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

heparin lock solution

  • 1unit/mL
  • 2units/mL
  • 10units/mL
  • 100units/mL

injectable solution

  • 1000units/mL
  • 2500units/mL
  • 5000units/mL
  • 10,000units/mL
  • 20,000units/mL

premixed IV solution

  • 12,500units/250mL
  • 20,000units/500mL
  • 25,000units/250mL
  • 25,000units/500mL

DVT & PE

Prophylaxis

  • 5000 units SC q8-12hr, OR
  • 7500 units SC q12hr

Treatment

  • 80 units/kg IV bolus, THEN continuous infusion of 18 units/kg/hr, OR  
  • 5000 units IV bolus, THEN continuous infusion of 1300 units/hr, OR
  • 250 units/kg (alternatively, 17,500 units) SC, THEN 250 units/kg q12hr

Dosing considerations

  • Numerous concentrations available; extreme caution is required to avoid medication error

Acute Coronary Syndromes

PCI

  • Without GPIIb/IIIa inhibitor: Initial IV bolus of 70-100 units/kg (target ACT 250-300 sec)  
  • With GPIIb/IIIa inhibitor: Initial IV bolus of 50-70 units/kg (target ACT >200 sec)

STEMI

  • Patient on fibrinolytics: IV bolus of 60 units/kg (max: 4000 units), THEN 12 units/kg/hr (max 1000 units/hr) as continuous IV infusion
  • Dose should be adjusted to maintain aPTT of 50-70 sec

Unstable Angina/NSTEMI

  • Initial IV bolus of 60-70 units/kg (max: 5000 units), THEN initial IV infusion of 12-15 units/kg/hr (max: 1000 units/hr)
  • Dose should be adjusted to maintain aPTT of 50-70 sec

Dosing considerations

  • Numerous concentrations available; extreme caution is required to avoid medication error

Anticoagulation

Intermittent IV injection

  • 8000-10,000 units IV initially, THEN 50-70 units/kg (5000-10,000 units) q4-6hr  

Continuous IV infusion

  • 5000 units IV injection, followed by continuous IV infusion of 20,000-40,000 units/24 hr

Dosing considerations

  • Numerous concentrations available; extreme caution is required to avoid medication error
  • Heparin sodium may prolong one-stage prothrombin time; when heparin sodium is given with dicumarol or warfarin sodium, a period of at least 5 hr after last intravenous dose or 24 hr after last subcutaneous dose should elapse before blood is drawn if a valid prothrombin time is to be obtained

Catheter Patency

Prevention of clot formation within venous and arterial catheters

Use 100 units/mL; instill enough volume to fill lumen of catheter

Dosing considerations

  • Numerous concentrations available; extreme caution is required to avoid medication error
  • Amount and frequency depends on catheter volume and type
  • Peripheral heparin locks typically are flushed q6-8hr

Dosing Modifications

Hepatic impairment: Caution is advised; dosage adjustment may be required

Dosage Forms & Strengths

heparin lock solution

  • 10units/mL
  • 100units/mL

injectable solution

  • 1000units/mL
  • 5000units/mL
  • 10,000units/mL

Venous Thromboembolic Prophylaxis (Off-label)

100-150 units/kg IV once  

Venous Thromboembolic Treatment (Off-label)

<1 year

  • Loading dose of 75 units/kg IV, THEN 28 units/kg/hr IV as initial maintenance dose  

>1 year

  • Loading dose of 75 units/kg IV, THEN 20 units/kg/hr IV as initial maintenance dose

Intermittent IV injection

  • Initially give 50-100 units/kg IV infusion, THEN 100 units/kg IV infusion q4hr as a maintenance dose

Catheter Patency (Off-label)

Initially give 50-100 units/kg IV infusion, THEN 100 units/kg IV infusion q4hr as maintenance dose  

Infants under 10 kg: 10 units/mL; instill enough volume to fill lumen of catheter

Children and infants over 10 kg: 10-100 units/mL; instill enough volume to fill lumen of catheter

Dosing Considerations

Numerous concentrations available; extreme caution is required to avoid medication error

When prescribing in infants, consider combined daily metabolic load of benzyl alcohol from all sources including heparin sodium injection (contains 9.45 mg of benzyl alcohol) and other drugs containing benzyl alcohol; the minimum amount of benzyl alcohol at which serious adverse reactions may occur is not known

There are no adequate, well-controlled studies on heparin use in pediatric patients; pediatric dosing recommendations are based on clinical experience

Use preservative-free heparin in neonates and infants; benzyl alcohol preservative has been associated with serious adverse effects (ie, gasping syndrome, which is characterized by central nervous system depression, metabolic acidosis, and gasping respirations) and death in pediatric patients

Venous thromboembolic treatment (off-label)

  • Adjust heparin dose based on desired aPTT

Catheter patency (off-label)

  • Dosage amount and frequency depend on catheter volume and type
  • Peripheral heparin locks typically are flushed q6-8hr
Next:

Interactions

Interaction Checker

and heparin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (4)

            • corticorelin

              heparin increases toxicity of corticorelin by unknown mechanism. Contraindicated. Do not use heparin to maintain IV cannula patency during corticorelin test; may lead to severe hypot'n.

            • defibrotide

              defibrotide increases effects of heparin by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

            • mifepristone

              mifepristone, heparin. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.

            • prothrombin complex concentrate, human

              heparin, prothrombin complex concentrate, human. pharmacodynamic antagonism. Contraindicated.

            Serious - Use Alternative (64)

            • abciximab

              heparin, abciximab. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • amobarbital

              amobarbital decreases effects of heparin by increasing metabolism. Avoid or Use Alternate Drug.

            • anagrelide

              heparin, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • antithrombin alfa

              antithrombin alfa and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • antithrombin III

              antithrombin III and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • apixaban

              heparin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • argatroban

              argatroban and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • azithromycin

              azithromycin increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

            • bazedoxifene/conjugated estrogens

              bazedoxifene/conjugated estrogens decreases effects of heparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • bemiparin

              bemiparin and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • bivalirudin

              bivalirudin and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • butabarbital

              butabarbital decreases effects of heparin by increasing metabolism. Avoid or Use Alternate Drug.

            • butalbital

              butalbital decreases effects of heparin by increasing metabolism. Avoid or Use Alternate Drug.

            • cefamandole

              cefamandole increases effects of heparin by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cefazolin

              cefazolin increases effects of heparin by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cefdinir

              cefdinir increases effects of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cefditoren

              cefditoren will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefotetan

              cefotetan increases effects of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cefoxitin

              cefoxitin will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefpodoxime

              cefpodoxime will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • ceftriaxone

              ceftriaxone will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefuroxime

              cefuroxime will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cilostazol

              heparin, cilostazol. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • clarithromycin

              clarithromycin increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

            • conjugated estrogens

              conjugated estrogens decreases effects of heparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • dabigatran

              dabigatran and heparin both increase anticoagulation. Avoid or Use Alternate Drug. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • dalteparin

              dalteparin and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • dipyridamole

              heparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • edoxaban

              edoxaban, heparin. Either increases toxicity of the other by anticoagulation. Avoid or Use Alternate Drug. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss. Long-term concomitant treatment with edoxaban and other anticoagulants is not recommended. Short-term coadministration may be needed for patients transitioning to or from edoxaban.

            • enoxaparin

              enoxaparin and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • eptifibatide

              heparin, eptifibatide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • erythromycin base

              erythromycin base increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              erythromycin lactobionate increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin stearate

              erythromycin stearate increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

            • estradiol

              estradiol decreases effects of heparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estrogens conjugated synthetic

              estrogens conjugated synthetic decreases effects of heparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estropipate

              estropipate decreases effects of heparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • ethinylestradiol

              ethinylestradiol decreases effects of heparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • Factor X, human

              heparin will decrease the level or effect of Factor X, human by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors.

            • fondaparinux

              fondaparinux and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • levonorgestrel intrauterine

              levonorgestrel intrauterine, heparin. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levonorgestrel oral

              levonorgestrel oral, heparin. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levothyroxine

              levothyroxine increases effects of heparin by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • liothyronine

              liothyronine increases effects of heparin by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • mestranol

              mestranol decreases effects of heparin by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • pentobarbital

              pentobarbital decreases effects of heparin by increasing metabolism. Avoid or Use Alternate Drug.

            • phenindione

              heparin and phenindione both increase anticoagulation. Avoid or Use Alternate Drug.

            • phenobarbital

              phenobarbital decreases effects of heparin by increasing metabolism. Avoid or Use Alternate Drug.

            • piperacillin

              piperacillin will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. piperacillin can inhibit platelet aggregation

            • prasugrel

              heparin, prasugrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • primidone

              primidone decreases effects of heparin by increasing metabolism. Avoid or Use Alternate Drug.

            • protamine

              heparin and protamine both increase anticoagulation. Avoid or Use Alternate Drug.

            • quinine

              quinine increases effects of heparin by unknown mechanism. Avoid or Use Alternate Drug.

            • roxithromycin

              roxithromycin increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

            • secobarbital

              secobarbital decreases effects of heparin by increasing metabolism. Avoid or Use Alternate Drug.

            • sulfadiazine

              sulfadiazine increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfadiazine increases effects of heparin by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfamethoxazole

              sulfamethoxazole increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfamethoxazole increases effects of heparin by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfisoxazole

              sulfisoxazole increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfisoxazole increases effects of heparin by plasma protein binding competition. Avoid or Use Alternate Drug.

            • thyroid desiccated

              thyroid desiccated increases effects of heparin by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • tibolone

              tibolone increases effects of heparin by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • ticlopidine

              heparin, ticlopidine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • tirofiban

              heparin, tirofiban. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • warfarin

              heparin and warfarin both increase anticoagulation. Avoid or Use Alternate Drug.

            Monitor Closely (147)

            • acalabrutinib

              acalabrutinib increases effects of heparin by anticoagulation. Use Caution/Monitor. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.

            • aceclofenac

              heparin and aceclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • acemetacin

              heparin and acemetacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • agrimony

              heparin and agrimony both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alfalfa

              heparin and alfalfa both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alteplase

              heparin and alteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • American ginseng

              heparin and American ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • anamu

              heparin and anamu both increase anticoagulation. Use Caution/Monitor.

            • antithrombin III

              antithrombin III increases effects of heparin by pharmacodynamic synergism. Use Caution/Monitor. Use reduced dose of heparin during antithrombin III therapy to avoid bleeding.

            • aspirin

              heparin and aspirin both increase anticoagulation. Modify Therapy/Monitor Closely.

              aspirin, heparin. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • aspirin rectal

              heparin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, heparin. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

              heparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • azapropazone

              azapropazone increases effects of heparin by plasma protein binding competition. Use Caution/Monitor.

            • azathioprine

              azathioprine decreases effects of heparin by unknown mechanism. Use Caution/Monitor.

            • azficel-T

              azficel-T, heparin. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

            • azilsartan

              heparin increases toxicity of azilsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • benazepril

              heparin increases toxicity of benazepril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • betrixaban

              heparin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • budesonide

              budesonide, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • canagliflozin

              heparin and canagliflozin both increase serum potassium. Use Caution/Monitor.

            • candesartan

              heparin increases toxicity of candesartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • capecitabine

              capecitabine increases effects of heparin by unspecified interaction mechanism. Use Caution/Monitor.

            • caplacizumab

              caplacizumab, heparin. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • captopril

              heparin increases toxicity of captopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • carbamazepine

              carbamazepine decreases levels of heparin by increasing metabolism. Use Caution/Monitor.

            • celecoxib

              heparin and celecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • chitosan

              chitosan increases effects of heparin by Other (see comment). Use Caution/Monitor. Comment: Chitosan can decrease GI absorption of vitamin K, enhancing anticoagulant effects.

            • choline magnesium trisalicylate

              heparin and choline magnesium trisalicylate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cinnamon

              heparin and cinnamon both increase anticoagulation. Modify Therapy/Monitor Closely.

            • citalopram

              citalopram increases effects of heparin by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

            • clopidogrel

              heparin, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Enhanced risk of hemorrhage; additive effects are intended when both drugs are prescribed as indicated for ACS.

            • collagenase clostridium histolyticum

              heparin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).

            • conjugated estrogens, vaginal

              conjugated estrogens, vaginal decreases effects of heparin by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Risk of thromboembolic disorders.

            • cordyceps

              heparin and cordyceps both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cornsilk

              cornsilk decreases effects of heparin by pharmacodynamic antagonism. Use Caution/Monitor. Cornsilk contains vitamin K; consume a consistent amount daily.

            • cortisone

              cortisone, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • cyclophosphamide

              cyclophosphamide increases effects of heparin by unknown mechanism. Use Caution/Monitor. Due to potential thrombocytopenic effects of cyclophosphamide, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • danshen

              heparin and danshen both increase anticoagulation. Use Caution/Monitor.

            • deferasirox

              deferasirox, heparin. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.

            • deflazacort

              deflazacort, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • devil's claw

              heparin and devil's claw both increase anticoagulation. Use Caution/Monitor.

            • dexamethasone

              dexamethasone, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • diclofenac

              heparin and diclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • diflunisal

              heparin and diflunisal both increase anticoagulation. Modify Therapy/Monitor Closely.

              diflunisal increases effects of heparin by plasma protein binding competition. Use Caution/Monitor.

            • dong quai

              heparin and dong quai both increase anticoagulation. Modify Therapy/Monitor Closely.

            • enalapril

              heparin increases toxicity of enalapril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • epoprostenol

              heparin and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

            • eprosartan

              heparin increases toxicity of eprosartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • ethanol

              ethanol increases effects of heparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

            • ethotoin

              heparin increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, heparin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • etodolac

              heparin and etodolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenbufen

              heparin and fenbufen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fennel

              heparin and fennel both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenoprofen

              heparin and fenoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • feverfew

              heparin and feverfew both increase anticoagulation. Modify Therapy/Monitor Closely.

            • finerenone

              heparin and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

            • fish oil

              fish oil, heparin. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of heparin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • fludrocortisone

              fludrocortisone, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • fluorouracil

              fluorouracil increases effects of heparin by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of fluorouracil, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • flurbiprofen

              heparin and flurbiprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • forskolin

              heparin and forskolin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fosinopril

              heparin increases toxicity of fosinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • fosphenytoin

              heparin increases levels of fosphenytoin by unknown mechanism. Use Caution/Monitor.

              fosphenytoin, heparin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • garlic

              heparin and garlic both increase anticoagulation. Modify Therapy/Monitor Closely.

            • gemcitabine

              gemcitabine increases effects of heparin by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of gemcitabine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • ginger

              heparin and ginger both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginkgo biloba

              heparin and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

            • glucagon intranasal

              glucagon intranasal increases effects of heparin by unknown mechanism. Use Caution/Monitor.

            • green tea

              green tea, heparin. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding, caution is advised.

            • hemin

              heparin, hemin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Hemin degradation product (ie, hematin) may produce coagulopathy (eg, thrombocytopenia, platelet degranulation) and cause mild anticoagulant effects.

            • horse chestnut seed

              heparin and horse chestnut seed both increase anticoagulation. Modify Therapy/Monitor Closely.

            • hydrocortisone

              hydrocortisone, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • ibrutinib

              ibrutinib will increase the level or effect of heparin by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • ibuprofen

              heparin and ibuprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ibuprofen IV

              heparin and ibuprofen IV both increase anticoagulation. Modify Therapy/Monitor Closely.

            • icosapent

              icosapent, heparin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

            • imatinib

              imatinib, heparin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin.

            • indomethacin

              heparin and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • iodine (radioactive)

              iodine (radioactive) decreases effects of heparin by pharmacodynamic antagonism. Use Caution/Monitor.

            • irbesartan

              heparin increases toxicity of irbesartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • ketoprofen

              heparin and ketoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac

              heparin and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac intranasal

              heparin and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • lisinopril

              heparin increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • lofepramine

              lofepramine increases levels of heparin by decreasing metabolism. Use Caution/Monitor.

            • lornoxicam

              heparin and lornoxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • losartan

              heparin increases toxicity of losartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • meclofenamate

              heparin and meclofenamate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • mefenamic acid

              heparin and mefenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • melatonin

              melatonin increases effects of heparin by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • meloxicam

              heparin and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • methimazole

              methimazole decreases effects of heparin by pharmacodynamic antagonism. Use Caution/Monitor.

            • methylprednisolone

              methylprednisolone, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • mipomersen

              mipomersen, heparin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

            • mistletoe

              heparin increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • moexipril

              heparin increases toxicity of moexipril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • nabumetone

              heparin and nabumetone both increase anticoagulation. Modify Therapy/Monitor Closely.

            • naproxen

              heparin and naproxen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • nettle

              heparin increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nintedanib

              nintedanib increases effects of heparin by anticoagulation. Use Caution/Monitor. Nintedanib is a VEGFR inhibitor, and may increase the risk of bleeding; monitor patients on full anticoagulation therapy; monitor closely for bleeding and adjust therapy as needed .

            • nitroglycerin rectal

              nitroglycerin rectal decreases effects of heparin by Other (see comment). Use Caution/Monitor. Comment: Although an interaction has been reported between IV heparin and nitroglycerin (resulting in a decrease in anticoagulant effect of heparin), the data are not consistent. If patients are to receive IV heparin and nitroglycerin concurrently, the anticoagulation status of the patient must be checked.

            • olmesartan

              heparin increases toxicity of olmesartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, heparin. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • omega 3 fatty acids

              omega 3 fatty acids, heparin. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • oxaprozin

              heparin and oxaprozin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • panax ginseng

              heparin and panax ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • parecoxib

              heparin and parecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pau d'arco

              heparin and pau d'arco both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pegaspargase

              pegaspargase increases effects of heparin by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.

            • perindopril

              heparin increases toxicity of perindopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • phenytoin

              heparin increases levels of phenytoin by unknown mechanism. Use Caution/Monitor.

              phenytoin, heparin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • phytoestrogens

              heparin and phytoestrogens both increase anticoagulation. Modify Therapy/Monitor Closely.

            • piroxicam

              heparin and piroxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • porfimer

              heparin decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.

            • potassium citrate/citric acid

              heparin and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

            • prednisolone

              prednisolone, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • prednisone

              prednisone, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • propafenone

              propafenone increases effects of heparin by decreasing metabolism. Use Caution/Monitor.

            • propylthiouracil

              propylthiouracil decreases effects of heparin by pharmacodynamic antagonism. Use Caution/Monitor.

            • quinapril

              heparin increases toxicity of quinapril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • ramipril

              heparin increases toxicity of ramipril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • reishi

              heparin and reishi both increase anticoagulation. Modify Therapy/Monitor Closely.

            • reteplase

              heparin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • rifabutin

              rifabutin decreases levels of heparin by increasing metabolism. Use Caution/Monitor.

            • rivaroxaban

              rivaroxaban, heparin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • sacubitril/valsartan

              heparin increases toxicity of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. Comment: Heparin may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • salicylates (non-asa)

              heparin and salicylates (non-asa) both increase anticoagulation. Modify Therapy/Monitor Closely.

            • salsalate

              heparin and salsalate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • saw palmetto

              saw palmetto increases toxicity of heparin by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

            • Siberian ginseng

              heparin and Siberian ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulfasalazine

              heparin and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulindac

              heparin and sulindac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • telmisartan

              heparin increases toxicity of telmisartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • tenecteplase

              heparin and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ticagrelor

              ticagrelor, heparin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

            • tipranavir

              tipranavir increases effects of heparin by pharmacodynamic synergism. Use Caution/Monitor. Tipranavir has mild antiplatelet activity that may incr bleeding risk.

            • tolfenamic acid

              heparin and tolfenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • tolmetin

              heparin and tolmetin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • trandolapril

              heparin increases toxicity of trandolapril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension, heparin. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • triclofos

              triclofos increases effects of heparin by unspecified interaction mechanism. Use Caution/Monitor.

            • valsartan

              heparin increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • voclosporin

              voclosporin and heparin both increase serum potassium. Use Caution/Monitor.

            • vorapaxar

              heparin, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • vortioxetine

              vortioxetine and heparin both increase anticoagulation. Use Caution/Monitor.

            • zanubrutinib

              heparin, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            Minor (21)

            • acetaminophen

              acetaminophen increases effects of heparin by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen IV

              acetaminophen IV increases effects of heparin by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen rectal

              acetaminophen rectal increases effects of heparin by unknown mechanism. Minor/Significance Unknown.

            • alprostadil intracavernous/urethral

              alprostadil intracavernous/urethral increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • aprotinin

              aprotinin increases effects of heparin by unspecified interaction mechanism. Minor/Significance Unknown.

            • ceftaroline

              ceftaroline increases effects of heparin by Other (see comment). Minor/Significance Unknown. Comment: Cephalosporins with a methylthiotetrazole (MTT) side ring (eg, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity.

            • chlorella

              chlorella decreases effects of heparin by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical, due to vitamin K content.

            • demeclocycline

              demeclocycline increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • dexmethylphenidate

              dexmethylphenidate increases effects of heparin by decreasing metabolism. Minor/Significance Unknown.

            • doxycycline

              doxycycline increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • glyburide

              glyburide increases effects of heparin by unspecified interaction mechanism. Minor/Significance Unknown.

            • mineral oil

              mineral oil decreases levels of heparin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • minocycline

              minocycline increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • nitroglycerin IV

              nitroglycerin IV decreases effects of heparin by unspecified interaction mechanism. Minor/Significance Unknown.

            • oxytetracycline

              oxytetracycline increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • protamine

              protamine decreases effects of heparin by Other (see comment). Minor/Significance Unknown. Comment: This combination produces an insoluble salt.

            • quinidine

              quinidine increases effects of heparin by decreasing metabolism. Minor/Significance Unknown.

            • tetracycline

              tetracycline increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • vasopressin

              heparin decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • verteporfin

              heparin decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • vitamin E

              vitamin E, heparin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Vitamin E at RDA does not change INR in pts. on chronic warfarin therapy; megadoses (~10x RDA) may enhance anticoagulant effects in vitamin K deficient pts.

            Previous
            Next:

            Adverse Effects

            >10%

            Heparin-induced thrombocytopenia, possibly delayed (10-30% )

            Frequency Not Defined

            Mild pain

            Hemorrhage

            Injection site ulcer (after deep SC injection)

            Increased liver aminotransferase

            Anaphylaxis

            Immune hypersensitivity reaction

            Osteoporosis (long-term, high-dose use)

            Postmarketing Reports

            Heparin resistance

            Gasping syndrome in infants due to benzyl alcohol preservative

            Hypersensitivity

            Necrosis of skin at site of subcutaneous injection

            Local irritation, erythema, mild pain, hematoma or ulceration following deep subcutaneous (intrafat) injection

            Risk of serious adverse reactions in infants due to benzyl alcohol

            Previous
            Next:

            Warnings

            Contraindications

            History of pentosan polysulfate-induced thrombocytopenia (HIT) (with or without thrombosis)

            Uncontrolled, active bleeding (except DIC)

            Conditions in which coagulation tests cannot be performed at appropriate intervals

            Cases where the administration of sodium or chloride could be clinically detrimental (large volume heparin 2 unit/mL IV solutions only)

            Known hypersensitivity to heparin or pork products

            Cautions

            Any risk factor for hemorrhage (eg, subacute bacterial endocarditis, blood dyscrasias, menorrhagia, dissecting aneurysm, major surgery, spinal anesthesia, hemophilia, GI ulcerative lesions, liver disease, impaired hemostasis)

            Hemorrhage can occur at virtually any site in patients receiving heparin; a higher incidence of bleeding reported in patients, particularly women, over 60 years of age; an unexplained fall in hematocrit, fall in blood pressure or any other unexplained symptom should lead to serious consideration of a hemorrhagic event

            Heparin-induced thrombocytopenia may occur (with or without thrombosis) including thrombus formation on a prosthetic cardiac valve; immune-mediated reaction resulting from irreversible aggregation of platelets; monitor thrombocytopenia of any degree; if platelet count falls below 100,000/m³, discontinue anticoagulants

            HIT occurs in patients treated with heparin and is due to the development of antibodies to a platelet Factor 4-heparin complex that induce in vivo platelet aggregation

            Monitor therapy with aPTT

            Heparin may prolong PT

            Potential medication errors: Do not use heparin sodium injection as a catheter lock-flush product; heparin sodium injection is supplied in vials containing various strengths of heparin; these include vials containing a highly concentrated solution of 10,000 units in 1 mL, which have been mistaken for 1 mL low-concentration catheter lock-flush vials

            Geriatric dosing: Lower doses may be necessary; patients over 60 years may have enhanced serum levels and response compared with patients under 60 years receiving similar dosages

            Heparin sodium may prolong one-stage prothrombin time; when heparin sodium is given with dicumarol or warfarin sodium, a period of at least 5 hr after last intravenous dose or 24 hr after last subcutaneous dose should elapse before blood is drawn if a valid prothrombin time is to be obtained

            If preserved with benzyl alcohol, do not administer to neonates, infants, pregnant women, or breastfeeding women; benzyl alcohol has been associated with serious adverse events and death, particularly in pediatric patients (gasping syndrome)

            Blood coagulation tests guide therapy for full-dose heparin; monitor platelet count and hematocrit in all patients receiving heparin, regardless of route of administration

            If coagulation test is unduly prolonged or if hemorrhage occurs, discontinue heparin promptly; periodically monitor platelet counts, hematocrit, and occult blood in stool during entire course of heparin therapy, regardless of route of administration

            Anticoagulant effect of heparin is enhanced by concurrent treatment with antithrombin III (human) in patients with hereditary antithrombin III deficiency; to reduce risk of bleeding, reduce heparin dose during concomitant treatment with antithrombin III (human)

            Heparin resistance may be observed in patients with antithrombin deficiency, increased heparin clearance, elevations of heparin binding proteins, elevations of in factor VIII and/or fibrinogen and may require doses >35,000 units/24hr to maintain therapeutic aPTT; frequently encountered in patients with fever, thrombosis, infections with thrombosing tendencies, thrombophlebitis, cancer, myocardial infarction, and postsurgical patients; may benefit from measurements of anticoagulant effects using antifactor Xa levels

            May suppress aldosterone production and cause hyperkalemia

            Use with caution in patients with documented hypersensitivity to heparin; use only in life-threatening situations when use of alternate anticoagulant is not possible

            Osteoporosis may occur with prolonged ( >6 months) use due to a reduction in mineral bone density

            Some preparations may contain sulfite which may cause allergic reactions

            Serious and fatal adverse reactions including “gasping syndrome” can occur in neonates and infants treated with benzyl alcohol-preserved drugs; consider combined daily metabolic load of benzyl alcohol from all sources including heparin sodium injection multiple-dose vials and other drugs containing benzyl alcohol hen prescribing multiple-dose vials in infants; minimum amount of benzyl alcohol at which toxicity may occur is not known

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy

            There are no available data on heparin sodium injection use in pregnant women to inform a drug- associated risk of major birth defects and miscarriage; in published reports, heparin exposure during pregnancy did not show evidence of increased risk of adverse maternal or fetal outcomes in humans

            There are no known adverse outcomes associated with fetal exposure to preservative benzyl alcohol through maternal drug administration; however, preservative benzyl alcohol can cause serious adverse events and death when administered intravenously to neonates and infants

            Animal data

            • No teratogenicity, but early embryo-fetal death reported in animal reproduction studies with administration of heparin sodium to pregnant rats and rabbits during organogenesis at doses approximately 10 times maximum recommended human dose (MRHD) of 45,000 units/ day; consider benefits and risks of heparin sodium Injection for mother and possible risks to fetus when prescribing heparin sodium injection to pregnant women

            Lactation

            There is no information regarding presence of heparin sodium injection in human milk, effects on breastfed infant, or on milk production; developmental and health benefits of breastfeeding should be considered along with mother's clinical need for heparin sodium injection and potential adverse effects on breastfed infant from therapy or from the underlying maternal condition

            If available, preservative-free heparin sodium injection is recommended when heparin therapy is needed during lactation; benzyl alcohol present in maternal serum is likely to cross into human milk and may be orally absorbed by a breastfed infant

            There is no information regarding presence of heparin sodium injection in human milk, effects on breastfed infant, or on milk production; due to its large molecular weight, heparin is not likely to be excreted in human milk, and any heparin in milk would not be orally absorbed by a breastfed infant

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Mechanism for low dose: Inactivates factor Xa and inhibits conversion of prothrombin to thrombin

            Mechanism for high dose: Inactivates factors IX, X, XI, and XII and thrombin and inhibits conversion of fibrinogen to fibrin

            Also inhibits activation of factor VIII

            Absorption

            Bioavailability: 22-40%

            Onset: IV (immediate); SC (20-30 min)

            Peak plasma time: 2-4 hr

            Distribution

            Protein bound: Extensive

            Metabolism

            Metabolized in the liver (partial) and reticuloendothelial system (partial)

            Metabolites: None

            Elimination

            Half-life: 60-90 min average (longer at higher doses)

            Dialyzable: No

            Excretion: Urine

            Previous
            Next:

            Administration

            IV Incompatibilities

            Additive

            • Dobutamine
            • Erythromycin
            • Gentamicin
            • Haloperidol
            • Hydrocortisone
            • Meperidine
            • Morphine
            • Vancomycin

            Syringe

            • Amiodarone
            • Diazepam
            • Erythromycin
            • Gentamicin
            • Haloperidol
            • Meperidine
            • Morphine(?)
            • Vancomycin

            Y-site

            • Amiodarone
            • Diazepam
            • Dobutamine
            • Gentamicin
            • Haloperidol
            • Vancomycin

            Not spec

            • Hydroxyzine
            • Tetracycline

            IV Compatibilities

            Additive

            • Aminophylline
            • Ampho B
            • Ampicillin
            • Ca gluconate
            • Clindamycin
            • Dopamine
            • Esmolol
            • Furosemide
            • Lidocaine
            • Norepinephrine
            • KCl
            • Na bicarbonate
            • Verapamil
            • Vitamins B/C

            Syringe

            • Aminophylline
            • Ampho B
            • Ampicillin
            • Atropine
            • Cimetidine
            • Clindamycin
            • Dobutamine
            • Dopamine
            • Epinephrine
            • Furosemide
            • Lidocaine
            • Morphine(?)
            • Norepinephrine
            • Na bicarbonate
            • Verapamil

            Y-site

            • Aminophylline, ampicillin, atropine, Ca gluconate, cimetidine, clindamycin, dopamine, epinephrine, erythromycin, esmolol, furosemide, hydrocortisone, lidocaine, norepinephrine, meperidine, morphine, KCl, Na bicarbonate

            IV Preparation

            Recommended infusion concentration for most patients is 25,000 units in 500 mL D5W (50 units/mL premixed infusion solution)

            IV Administration

            IV injection may be given undiluted or diluted in 50-100 mL NS or D5W

            Infusion: Dilute in NS, D5W, or other compatible fluid

            Continuous IV therapy is preferred because intermittent IV therapy produces a higher incidence of bleeding abnormalities

            Invert IV bag at least 6 times to ensure mixing and prevent pooling of medication

            Use constant-rate IV infusion pump

            Storage

            Store heparin solutions at room temperature; do not freeze

            Do not use if discolored/precipitates

            Autoclavable

            Previous
            Next:

            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            heparin lock flush (porcine) intravenous
            -
            10 unit/mL vial
            heparin lock flush (porcine) intravenous
            -
            100 unit/mL vial
            heparin lock flush (porcine) intravenous
            -
            10 unit/mL vial
            heparin lock flush (porcine) intravenous
            -
            100 unit/mL vial

            Copyright © 2010 First DataBank, Inc.

            Previous
            Next:

            Patient Handout

            Patient Education
            heparin lock flush (porcine) intravenous

            HEPARIN LOCK FLUSH-INJECTION

            (HEP-a-rin)

            COMMON BRAND NAME(S): Hep-Lock

            USES: This medication is used to keep IV catheters open and flowing freely. Heparin helps to keep blood flowing smoothly and from clotting in the catheter by making a certain natural substance in your body (anti-clotting protein) work better. It is known as an anticoagulant.This form of heparin must not be used to treat or prevent blood clots in the body.Some products should not be used for newborns due to an increased risk of side effects. Check with your doctor or pharmacist for more details.

            HOW TO USE: This medication is given by injection into the IV catheter as directed by your doctor. Do not inject this medication into the body.Heparin comes in many strengths. Serious (sometimes fatal) injuries have occurred when the wrong strength was used. Check that you are using the correct strength and dose before injecting this medication.Flush the catheter/line with normal saline before and after infusing drugs that interact with heparin such as doxorubicin, droperidol, ciprofloxacin, and mitoxantrone.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

            SIDE EFFECTS: Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Although very unlikely, this medication can cause bleeding if its effect on your clotting proteins is too much. Tell your doctor right away if you develop any signs of serious bleeding, including unusual pain/swelling/discomfort, prolonged bleeding from cuts or gums, persistent nosebleeds, unusually heavy/prolonged menstrual periods, unusual/easy bruising, dark urine, black stools, severe headache, unusual dizziness.Some patients can have certain bad reactions to heparin (heparin-induced thrombocytopenia-HIT or heparin-induced thrombocytopenia and thrombosis-HITT). This can occur during treatment and up to several weeks after treatment with heparin has stopped. You should not use this drug again if you have this type of reaction with heparin.Get medical help right away if you have any very serious side effects, including: pain/loss of feeling in the arms/legs, change in color of the arms/legs, chest pain, trouble breathing, confusion, weakness on one side of the body, trouble speaking, vision changes.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using heparin, tell your doctor or pharmacist if you are allergic to it; or to pork products; or to pentosan polysulfate sodium; or if you have any other allergies. This product may contain inactive ingredients (such as benzyl alcohol found in some brands), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication does not pass into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.This medication may interfere with certain laboratory tests (including prothrombin time), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: easy/unusual bruising, easy/unusual bleeding such as persistent nosebleeds, blood in urine, black stools.

            NOTES: Not applicable.

            MISSED DOSE: Not applicable.

            STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.