heparin

Generic Name: heparin (HEP a rin)
Brand names: Hep-Pak (obsolete), Heparin Lock Flush (obsolete), Hep-Pak CVC (obsolete), Hep-Lock (obsolete)

What is heparin?

Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots.

Heparin is used to treat and prevent blood clots in the veins, arteries, or lung. Heparin is also used before surgery to reduce the risk of blood clots.

Heparin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about heparin?

Before using heparin, tell your doctor if you have high blood pressure, an infection involving your heart, hemophilia or other bleeding disorder, a stomach or intestinal disorder, liver disease, or if you are on your period.

Heparin can cause you to have bleeding episodes while you are using it and for several weeks after you stop. Call your doctor at once if you have easy bruising or unusual bleeding, such as a nosebleed, black or bloody tarry stools, or any bleeding that will not stop. Certain medicines can increase your risk of bleeding while you are using heparin, such as aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) including ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Women over 60 years of age may be more likely to have bleeding episodes while using heparin.

What should I discuss with my healthcare provider before using heparin?

Do not use this medication if you are allergic to heparin, or if you have:

• a severe lack of platelets in your blood; or

• uncontrolled bleeding.

Before using heparin, tell your doctor if you are allergic to any drugs, or if you have:

• an infection of the lining of your heart (also called bacterial endocarditis);

• uncontrolled high blood pressure;

• a bleeding or blood clotting disorder, such as hemophilia;

• a stomach or intestinal disorder;

• liver disease; or

• if you are having a menstrual period.

If you have any of these conditions, you may not be able to use heparin, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Before using heparin, tell your doctor if you are pregnant or plan to become pregnant during treatment. Do not use this medication without telling your doctor if you are breast-feeding a baby. Women over 60 years of age may be more likely to have bleeding episodes while using heparin.

How should I use heparin?

Heparin is given as an injection into your skin or through a needle placed into a vein. Your doctor, nurse, or other healthcare provider will give you this injection. You may be given instructions on how to use your injections at home.

Heparin must not be injected into a muscle. Do not use this medicine at home if you do not fully understand how to give the injection and properly dispose of needles and other items used in giving the medicine.

Use each needle and syringe only one time. With your medicine you will receive a puncture-proof container for used needles and syringes. If you do not receive a container, ask your pharmacist for one. Keep this container out of the reach of children and pets. Your pharmacist can tell you how to properly dispose of the container.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your stools may also need to be checked for blood. Do not miss any scheduled visits to your doctor.

Do not use the medication if it has changed colors or has any particles in it. Call your doctor for a new prescription.

You may be switched from injectable heparin to an oral (taken by mouth) blood thinner. Do not stop using the heparin until your doctor tells you to. You may need to use both the injection and the oral forms of heparin for a short time. Store heparin at room temperature away from moisture and heat.

What happens if I miss a dose?

Contact your doctor for instructions if you miss a dose of heparin.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include easy bruising, nosebleeds, blood in your urine or stools, black or tarry stools, or any bleeding that will not stop.

What should I avoid while using heparin?

Avoid taking other medicines that can increase your risk of bleeding, such as aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) including ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.

Heparin side effects

Heparin can cause you to have bleeding episodes while you are using it and for several weeks after you stop. Call your doctor at once if you have easy bruising or unusual bleeding, such as a nosebleed, blood in your urine or stools, black or tarry stools, or any bleeding that will not stop. Get emergency medical help if you have any of these signs of an allergic reaction: nausea, vomiting, sweating, hives, itching, trouble breathing, swelling of your face, lips, tongue, or throat, or feeling like you might pass out..

Some people receiving a heparin injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your caregiver right away if you feel nauseated, light-headed, sweaty, or short of breath during or after a heparin injection.

Stop using heparin and call your doctor at once if you have any of these serious side effects:

• sudden numbness or weakness, especially on one side of the body;

• sudden headache, confusion, problems with vision, speech, or balance;

• pain or swelling in one or both legs;

• trouble breathing; or

• fever, chills, runny nose, or watery eyes.

Less serious side effects may include:

• mild pain, redness, warmth, or skin changes where the medicine was injected;

• mild itching of your feet; or

• bluish-colored skin.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Heparin Dosing Information

Usual Adult Dose for Deep Vein Thrombosis:

Continuous IV Infusion: 5000 units IV one time as a bolus dose followed by 1300 units/hour by continuous IV infusion. Alternatively, a bolus dose of 80 units/kg IV one time followed by 18 units/kg/hour by continuous IV infusion may be used.
Intermittent subcutaneous injection: 17,500 units subcutaneously every 12 hours.
The dosage should be adjusted to maintain the aPTT at 1.5 to 2.5 times control.

Usual Adult Dose for Deep Vein Thrombosis -- Prophylaxis:

5000 units subcutaneously every 8 to 12 hours. This dosage may be adjusted to maintain the aPTT at the upper end of the normal range.

Usual Adult Dose for Pulmonary Embolism:

Continuous IV Infusion: 5000 units IV one time as a bolus dose followed by 1300 units/hour by continuous IV infusion. Alternatively, a bolus dose of 80 units/kg IV one time followed by 18 units/kg/hour by continuous IV infusion may be used.
If it is suspected that the patient has experienced a massive pulmonary embolism, a more appropriate initial dosage may be an IV bolus of 10,000 units followed by 1500 units/hour.
Intermittent subcutaneous injection: 17,500 units subcutaneously every 12 hours.
The dosage should be adjusted to maintain the aPTT at 1.5 to 2.5 times control.

Usual Adult Dose for Myocardial Infarction:

5000 units IV one time as a bolus dose followed by 1000 units/hour by continuous IV infusion.

Usual Adult Dose for Angina Pectoris:

5000 units IV one time as a bolus dose followed by 1000 units/hour by continuous IV infusion.

Usual Adult Dose for Anticoagulation During Pregnancy:

5000 units subcutaneously every 12 hours. This dosage may be adjusted to maintain the 6-hour aPTT at 1.5 times control or greater.

Usual Adult Dose for Thrombotic/Thromboembolic Disorder:

100 units/mL every 6 to 8 hours for PVC catheters and peripheral heparin locks. Additional flushes should be given when stagnant blood is observed in catheter, after catheter is used for drug or blood administration, and after blood withdrawal from catheter.

Addition of 0.5 to 1 unit/mL to peripheral and central TPN has been shown to increase duration of line patency. Arterial lines are heparinized with a final concentration of 1 unit/mL.

Usual Pediatric Dose for not applicable:

Less than 1 year:
Continuous IV infusion: 75 units/kg IV one time as a bolus dose followed by 28 units/kg/hour by continuous IV infusion. Adjust dose to maintain aPTT of 60 to 85 seconds.

1 year or older:
Intermittent IV Injection: 50 to 100 units/kg, then 50 to 100 units IV every 4 hours.
Continuous IV infusion: 75 units/kg given over 10 minutes, followed by an initial maintenance dose of 20 units/kg/hour. Adjust dose to maintain aPTT of 60 to 85 seconds.

Usual Pediatric Dose for Thrombotic/Thromboembolic Disorder:

IV line flush:
Infant Dose: 10 units/mL every 6 to 8 hours.

Child Dose: 100 units/mL every 6 to 8 hours for PVC catheters and peripheral heparin locks. Additional flushes should be given when stagnant blood is observed in catheter, after catheter is used for drug or blood administration, and after blood withdrawal from catheter.

Addition of 0.5 to 1 unit/mL to peripheral and central TPN has been shown to increase duration of line patency. Arterial lines are heparinized with a final concentration of 1 unit/mL.

What other drugs will affect heparin?

Before using heparin, tell your doctor if you are using any of the following drugs:

• another blood thinner, such as warfarin (Coumadin);

• salicylates such as aspirin, Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others;

• dipyridamole (Persantine);

• nicotine cigarettes, gum, lozenges, or skin patches;

• cold, allergy, or sleep medications (Allerest, Benadryl, Chlor-Trimeton, Dimetapp, Sominex, and others);

• hydroxychloroquine (Plaquenil, Quineprox);

• digoxin (digitalis, Lanoxin, Lanoxicaps); or

• demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

This list is not complete and there may be other drugs that can interact with heparin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about heparin.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with other, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 4.03. Revision Date: 4/12/2009 4:36:40 PM.

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