Heparin sodium, 5000 IU/ml, solution for intravenous and subcutaneous administration, 5 ml, 5 pcs.

Heparin

Heparin is administered subcutaneously, intravenously, bolus or drip.

Heparin is prescribed as a continuous intravenous infusion or as regular intravenous injections, as well as subcutaneously (in the abdomen).

Heparin cannot be administered intramuscularly. The usual site for subcutaneous injections is the anterolateral abdominal wall (in exceptional cases in the upper arm or thigh), using a thin needle that should be inserted deeply, perpendicularly, into a fold of skin, held between the thumb and forefinger until the injection is complete. solution. The injection sites should be alternated each time (to avoid the formation of a hematoma).

The first injection must be performed 1-2 hours before the start of surgery; in the postoperative period, administer for 7-10 days, and if necessary, for a longer period.

Initial dose

sodium heparin administered for therapeutic purposes is usually 5000 IU and is administered intravenously, after which treatment is continued using subcutaneous injections or intravenous infusions.

Maintenance doses

determined depending on the method of application:

- for continuous intravenous infusion, 1000-2000 IU/hour (24000-48000 IU/day) is prescribed, diluting sodium heparin in the following solutions for infusion: 0.9% sodium chloride solution, 5% and 10% glucose solution, 0.45% sodium chloride solution and 2.5% glucose solution in Ringer's solution;

- with regular intravenous injections, 5000-10000 IU of sodium heparin is prescribed every 4-6 hours;

— for subcutaneous administration, 15,000-20,000 IU is administered every 12 hours or 8,000-10,000 IU every 8 hours.

Before each dose, it is necessary to conduct a study of blood clotting time and/or aPTT in order to adjust the subsequent dose.

Doses of heparin sodium when administered intravenously are selected so that the aPTT is 1.5-2.5 times greater than the control. The anticoagulant effect of heparin is considered optimal if the blood clotting time is extended by 2-3 times compared to the normal value, the aPTT and thrombin time are increased by 2 times (if continuous monitoring of the aPTT is possible).

With subcutaneous administration of small doses (5000 IU 2-3 times a day) for the prevention of thrombus formation, regular monitoring of aPTT is not required, since it increases slightly.

Continuous intravenous infusion is the most effective way of using sodium heparin, better than regular (periodic) injections, as it provides more stable hypocoagulation and is less likely to cause bleeding.

For adults with mild to moderate thrombosis, 40,000-50,000 IU/day is administered intravenously in 3-4 doses; for severe thrombosis or embolism - 20,000 IU intravenously 4 times a day with an interval of 6 hours.

For health reasons, 25,000 IU is administered intravenously once, then 20,000 IU every 4 hours until the daily dose is 80,000-120,000 IU.

When administered intravenously, at least 40,000 IU is added to the daily volume of the infusion solution.

When performing extracorporeal circulation, Heparin is administered at a dose of 140-400 IU/kg or 1500-2000 IU per 500 ml of preserved blood (whole blood, red blood cells).

For patients on dialysis, dose adjustment is carried out based on the results of a coagulogram.

During hemodialysis, 10,000 IU per 500 ml of blood is first administered intravenously, then in the middle of the procedure another 30,000-50,000 IU is administered. For elderly patients, especially women, doses should be reduced.

For children

the drug is administered intravenously: at the age of 1-3 months - 800 IU/kg/day, 4-12 months - 700 IU/kg/day, over 6 years - 500 IU/kg/day under APTT control.

The duration of Heparin therapy depends on the indications and route of administration. For intravenous use, the optimal duration of treatment is 7-10 days, after which therapy is continued with oral anticoagulants (it is recommended to prescribe oral anticoagulants starting from the 1st day of treatment with Heparin or from 5 to 7 days, and stop using Heparin on the 4-5 day of combination therapy) . In case of extensive thrombosis of the iliofemoral veins, it is advisable to carry out longer courses of treatment with Heparin.

Compound

The injection solution contains sodium heparin at a concentration of 5 thousand units/ml.
The auxiliary components of the drug include sodium chloride, benzyl alcohol, and water. 1 gram of gel contains 1 thousand units of sodium heparin , as well as auxiliary components: 96% ethanol, carbomer , dimethyl sulfoxide, propylene glycol, dietanolamine, methyl and propylparaben (additives E 218, E 216), lavender oil and purified water.

Indications for use

Indications for use of the gel

Heparin gel is used for the treatment and prevention of thrombophlebitis of the superficial veins , phlebitis (post-injection and post-infusion), lymphangitis , superficial periphlebitis, elephantiasis, localized infiltrates, bruises, swelling and injuries (including muscles, joints, tendons), superficial mastitis , subcutaneous hematomas .

Indications for use of the solution

Heparin injections are prescribed for thrombosis of deep veins , myocardial arteries , renal veins , pulmonary embolism, thrombophlebitis , atrial fibrillation (including if cardiac arrhythmia is accompanied by embolization), unstable angina , disseminated intravascular coagulation syndrome , acute myocardial infarction, mitral heart disease (prevention of blood clots ), bacterial endocarditis , hemolyticouremic syndrome , lupus nephritis , glomerulonephritis , for the prevention and treatment of microthrombosis and microcirculation disorders.

For preventive purposes, the drug is used during surgical interventions that use extracorporeal blood circulation methods, during cytapheresis, peritoneal dialysis, hemodialysis, forced diuresis, hemosorption, and when washing venous catheters.

When Heparin is administered intravenously, blood clotting slows down almost immediately, when administered into a muscle - after 15-30 minutes, when administered subcutaneously - after 20-60 minutes, when administered by inhalation, the effect is most pronounced after 24 hours.

Contraindications

Heparin containing ointments (Heparin, Heparin-Acrigel 1000, etc.) are contraindicated in cases of hypersensitivity to the components they contain, as well as in diseases accompanied by ulcerative-necrotic processes, and injuries that are accompanied by violations of the integrity of the skin.

Heparin gel (ointment) should be used with caution in case of thrombocytopenia and increased tendency to bleeding.

Contraindications to the use of the injection form of the drug:

• hypersensitivity;
• diseases accompanied by increased bleeding ( vasculitis, hemophilia , etc.);
• bleeding;
• aortic dissection , intracranial aneurysm;
• antiphospholipid syndrome;
• traumatic brain injury;
• hemorrhagic stroke;
• uncontrolled hypertension;
• liver cirrhosis , accompanied by pathological changes in the veins of the esophagus;
• threatened miscarriage;
• menstrual period;
• pregnancy;
• childbirth (including recent);
• lactation period;
• erosive and ulcerative lesions of the stomach and intestinal tract;
• recent surgical interventions on the prostate gland, brain, eyes, bile ducts and liver, as well as the condition after lumbar puncture .

Heparin injections should be prescribed with caution to patients with polyvalent allergies (including bronchial asthma ), diabetes mellitus , arterial hypertension , active tuberculosis , endo- and pericarditis , chronic renal failure, liver failure ; patients undergoing dental procedures or radiation therapy; persons over 60 years of age (especially women); women using an IUD.

Use during pregnancy and lactation

Heparin solution is not contraindicated for pregnant women. However, despite the fact that the active substance of the drug does not penetrate into milk, its use in nursing mothers in some cases led to the rapid (within 2-4 weeks) development of osteoporosis and spinal damage.

The feasibility of use should be decided individually, taking into account the risk to the fetus/benefit to the mother ratio.

There are no data on the use of the gel during pregnancy and lactation.

Analogs

Level 4 ATC code matches:
Girudoproct

Heparoid Zentiva

Heparin ointment

Gepatrombin G

Lyoton

Trombless

Venolife

Hepatrombin

Gel analogues: Heparin-Acrigel 1000 , Lyoton 1000 , Lavenum , Trombless .

Generic injection forms: Heparin J , Heparin-Ferein , Heparin-Sandoz .

Drugs with a similar mechanism of action: tablets - Piyavit , Angioflux , Wessel Due F ; solution - Angioflux , Hemapaxan , Antithrombin III human , Wessel Due F , Fluxum , Anfibra , Fraxiparine , Enixum .

Interaction

Drugs that block tubular secretion, indirect anticoagulants that reduce the formation of vitamin K by intestinal microflora, antibiotics, NSAIDs, dipyridamole , ASA and other drugs that reduce platelet aggregation enhance the effect of heparin.

The weakening of the effect is facilitated by: cardiac glycosides , ergot alkaloids , phenothiazines , antihistamines, nicotine , ethacrynic and nicotinic acids , nitroglycerin (iv administration), ACTH, tetracyclines , alkaline amino acids and polypeptides, thyroxine , protamine .

Do not mix the solution in the same syringe with other medications.

When applied topically, the anticoagulant effect of the drug is enhanced when the gel is used in combination with antiplatelet agents, NSAIDs, and anticoagulants. Tetracycline , thyroxines , nicotine and antihistamines reduce the effect of heparin.

Side effects

When used externally, Heparin sodium can cause skin hyperemia and hypersensitivity reactions.

When administering the solution, the following are possible:

• Hypersensitivity reactions ( drug fever , skin hyperemia, rhinitis , feeling of heat in the soles, urticaria , skin itching, collapse, bronchospasm , anaphylactic shock ).
• Headaches, dizziness, diarrhea, loss of appetite, nausea, vomiting;
• Thrombocytopenia (in approximately 6% of patients), sometimes (rarely) with death. Heparin-induced thrombocytopenia (HIT) is accompanied by: arterial thrombosis , skin necrosis and gangrene , stroke , myocardial infarction . In case of severe HIT (when the platelet is reduced to half the original number or below 100 thousand/μl), heparin should be stopped immediately.
• Local reactions ( hematoma , hyperemia , pain, ulceration, irritation at the injection site, bleeding).
• Bleeding. Typical ones are considered to be from the urinary tract and gastrointestinal tract, in areas that are subject to pressure, at the site of drug administration, from surgical wounds. Hemorrhages are also possible in various internal organs: in the retroperitoneal space, corpus luteum, adrenal glands, etc.

With long-term use of Heparin, intermittent alopecia , osteoporosis , hypoaldosteronism , soft tissues become calcified, spontaneous bone fractures occur, and the activity of liver transaminases increases.

pharmachologic effect

Pharmacological group: anticoagulants .

Group of the drug Heparin, produced in the form of a gel: drugs for the treatment of cardiovascular diseases.

Group of the drug Heparin, produced in injection form: agents affecting blood and hematopoiesis.

Heparin sodium contained in the drug has an antithrombotic effect , slows down the aggregation and adhesion of leukocytes , platelets and erythrocytes ; reduces wall spasm and the degree of vascular permeability; helps improve collateral circulation.

Overdose

Symptoms of overdose with parenteral use are bleeding of varying severity.

Treatment: for minor bleeding caused by an overdose of the drug, it is enough to stop using it. If bleeding is extensive, protamine sulfate (1 mg per 100 IU of heparin) is used to neutralize excess heparin.

Please note that heparin is eliminated quickly. Thus, if protamine sulfate is administered 30 minutes after the previous dose of heparin, it should be administered at half the dose; The highest dose of protamine sulfate is 50 mg.

It is not excreted by hemodialysis.

Cases of overdose with external use of the drug have not been described. Due to the low systemic absorption of the drug, an overdose is considered unlikely. With prolonged use on large surfaces, hemorrhagic complications .

Treatment: discontinuation of the drug, if necessary, use of a one percent solution of protamine sulfate (heparin antagonist).