1 vial 25,000 IU in 5ml

$3.64

Heparin, Multiparin

  • Anticoagulation

IV:
5000 units/ml in 5ml vials (25000 units); other formulations also available
For administration of heparin by infusion, prepare 25000 units of heparin in 50mls of compatible IV fluid
Administer via a dedicated central line or peripheral line.
Discard any solution not used within 24 hours or preparation
Compatible with the following IV fluids:
5% dextrose Normal saline Glucose and sodium chloride
Hartmanns
Store at room temperature


ADULT DOSE

IV:
Use the following protocol for heparin infusion in the ICU ONLY (print an individualised heparin infusion protocol from the database). All doses are in units/kg and should be rounded to the nearest 100 units (note: 100 units equals 0.2ml when heparin is prepared according to the standard dilution above). APTT should be measured 6 hourly.

Heparin Dosing

(Adapted from Raschke RA, Reilly BM, Guidry JR, et al: The weight-based heparin dosing nomogram compared with a "standard care" nomogram. Ann Intern Med 1993;119:874.)

PAEDIATRIC DOSE

IV
75-200 units/kg stat followed by infusion commencing at 15 units/kg/hr
Infusion made up as follows: 500 units / kg in 50ml at 0-2.5 ml/hr (0-25 units/kg/hr) adjusted according to APTT

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose as in normal renal function

Heparin inhibits reactions that lead to the clotting of blood and the formation of fibrin clots both in vitro and in vivo. Heparin acts at multiple sites in the normal coagulation system. Small amounts of heparin in combination with antithrombin III (heparin cofactor) can inhibit thrombosis by inactivating activated Factor X and inhibiting the conversion of prothrombin to thrombin.

CONTRAINDICATIONS:

  • Severe thrombocytopaenia

  • Heparin Induced Thromobsis-Thrombocytopaenia Syndrome (HITTS)


WARNINGS
Hypersensitivity
Patients with documented hypersensitivity to heparin should be given the drug only in clearly life-threatening situations.
Haemorrhage
Haemorrhage can occur at virtually any site in patients receiving heparin. An unexplained fall in hematocrit, fall in blood pressure, or any other unexplained symptom should lead to serious consideration of a haemorrhagic event.
Heparin sodium should be used with extreme caution in disease states in which there is increased danger of haemorrhage

Thrombocytopaenia
Thrombocytopaenia has been reported to occur in patients receiving heparin with a reported incidence of 0% to 30%. Mild thrombocytopaenia (count greater than 100,000/mm3) may remain stable or reverse even if heparin is continued. However, reduction in platelet count of any degree should be monitored closely. If the count falls below 100,000/mm3 or if recurrent thrombosis develops, the heparin product should be discontinued.

PRECAUTIONS
General
Heparin Induced Thromobsis-Thrombocytopaenia Syndrome (HITTS):
It has been reported that patients on heparin may develop new thrombus formation in association with thrombocytopaenia resulting from irreversible aggregation of platelets induced by heparin, the so-called "white clot syndrome". The process may lead to severe thromboembolic complications like skin necrosis, gangrene of the extremities that may lead to amputation, myocardial infarction, pulmonary embolism, stroke, and possibly death. Therefore, heparin administration should be promptly discontinued if a patient develops new thrombosis in association with a reduction in platelet count.

Heparin Resistance:
Increased resistance to heparin is frequently encountered in fever, thrombosis, thrombophlebitis, infections with thrombosing tendencies, myocardial infarction, cancer, in postsurgical patients, and patients with antithrombin III deficiency.
Laboratory Tests
Patients in ICU on a heparin infusion should have their aPTT measured 6 hourly.

Drug/Laboratory Test Interactions
None noted

Pregnancy
Animal reproduction studies have not been conducted with heparin sodium. It is also not known whether heparin sodium can cause foetal harm when administered to a pregnant woman or can affect reproduction capacity. Heparin sodium should be given to a pregnant woman only if clearly needed.

Nursing Mothers
Heparin is not excreted in human milk.

Paediatric Use
See DOSAGE IN PAEDIATRICS

Concomitant administration with warfarin, aspirin, activated protein C and enoxaparin increases the risk of bleeding.
Digitalis, tetracyclines, nicotine, or antihistamines may partially counteract the anticoagulant action of heparin sodium.

Body as a Whole:
Haemorrhage, anaphylactic reactions
Gastrointestinal System:
Nausea, vomiting
Respiratory System:
Angioedema, asthma-like symptoms
Haematological System:
Thrombocytopaenia, HITTS (see PRECAUTIONS)

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