Dextrose / Heparin

Heparin Sodium in 5% Dextrose Injection is an intravenous anticoagulant (blood thinner) used to prevent and treat dangerous blood clots and related complications. All uses below apply to the IV formulation.

• Prevention and treatment of venous thrombosis (clots in the veins)
• Prevention and treatment of pulmonary embolism (clots in the lungs)
• Prevention and treatment of thromboembolic complications associated with atrial fibrillation
• Treatment of acute and chronic disseminated intravascular coagulation (DIC) — a dangerous condition where abnormal clotting and bleeding occur simultaneously
• Prevention of clotting during arterial and cardiac surgery
• Prevention and treatment of peripheral arterial embolism (clots blocking arteries in the limbs)
• Anticoagulant use during blood transfusions, extracorporeal (heart-lung bypass) circulation, and dialysis procedures

Heparin works by activating a natural blood protein called Antithrombin III. Once activated, Antithrombin III dramatically speeds up the shutdown of key clotting factors — especially Factor Xa and Factor IIa (thrombin). Heparin also blocks the final step of clot formation, preventing a stable fibrin mesh from being built. The result: new clots are stopped from forming, and existing ones can't grow. Heparin does not dissolve clots that already exist.

In some patients — including those with fever, active infection, cancer, heart attack, or a deficiency of Antithrombin III — heparin may be less effective (a phenomenon called heparin resistance). In those cases, more frequent blood monitoring and dose adjustments are needed.

Heparin Sodium in 5% Dextrose Injection is given by continuous intravenous infusion or intermittent IV injection in a hospital or clinical setting — it cannot be taken by mouth. Dosing is highly individualized and adjusted based on regular blood clotting tests (such as APTT). Your care team will monitor these results and adjust the rate of infusion accordingly.

• For continuous IV infusion, the infusion runs around the clock; clotting time is checked approximately every 4 hours early in treatment
• For intermittent IV injection, clotting tests are done before each injection in the early stages
• During cardiovascular surgery and dialysis, dosing follows specific protocols based on body weight and the equipment being used
• Platelet counts and blood counts (hematocrits) should also be checked regularly throughout therapy

The most common side effects of heparin include:

• Bleeding — the most frequent and potentially serious complication
• Low platelet count (thrombocytopenia)
• Heparin-induced thrombocytopenia and thrombosis (HIT/HITT) — a serious immune reaction
• High potassium levels (hyperkalemia)
• Elevated liver enzymes (AST and ALT)
• Allergic reactions: chills, fever, hives, and rarely severe anaphylactic shock
• Redness, pain, or ulceration at the infusion site
• With long-term high-dose use: bone thinning (osteoporosis) and temporary hair loss

Bleeding is the most important side effect to watch for. Any unusual bruising, blood in urine or stool, or unexpected drop in blood pressure should be reported to your care team immediately.

• Fatal medication errors: Heparin comes in multiple concentrations. Confirming the correct strength before administration is critical — errors have caused fatal bleeding.
• Serious bleeding risk: Bleeding can occur anywhere in the body, including rare but life-threatening sites like the adrenal glands or behind the abdomen. People over 60 (especially women) face a higher risk. Blood pressure drops or falling blood counts should prompt immediate evaluation.
• HIT and HITT: Heparin can trigger an immune reaction that dangerously lowers platelet counts and, paradoxically, causes new blood clots. This can occur 5–10 days into treatment or within 24 hours in recently exposed patients. If suspected, heparin must be stopped immediately.
• Hyperkalemia (high potassium): Heparin can suppress the hormone aldosterone, raising potassium levels — especially in people with diabetes, kidney disease, or those on potassium-sparing medications. Potassium should be monitored during extended therapy.
• Hypersensitivity: This product contains sodium metabisulfite, which can cause severe allergic reactions in susceptible individuals, particularly those with asthma.
• Heparin resistance: Fever, active infection, cancer, and certain other conditions can make heparin less effective. More frequent monitoring may be needed.

Several medications can interfere with heparin's blood-thinning effect — either increasing your bleeding risk or reducing how well heparin works:

• Warfarin and other oral anticoagulants — combined use increases bleeding risk; timing of lab tests must be carefully coordinated
• NSAIDs (aspirin, ibuprofen, naproxen, indomethacin, celecoxib) — impair platelet function and raise bleeding risk with heparin
• Antiplatelet drugs (clopidogrel, dipyridamole, abciximab, eptifibatide, tirofiban) — significantly increase bleeding risk
• Hydroxychloroquine and dextran — interfere with platelet aggregation; use with caution
• Intravenous nitroglycerin — can reduce heparin's effect; a rebound increase in clotting may occur when nitroglycerin is stopped
• Digitalis, tetracyclines, nicotine, antihistamines — may partially counteract heparin's anticoagulant effect
• Antithrombin III (human) — dramatically amplifies heparin's effect in certain patients; heparin dose reduction is required to avoid excessive bleeding

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• Do not use if you have a history of HIT (heparin-induced thrombocytopenia) or HITT — this is an absolute contraindication
• Do not use if you are allergic to heparin or pork products — heparin is derived from animal tissue
• Do not use if you have uncontrolled active bleeding (unless caused by DIC)
• Do not use if adequate blood clotting tests cannot be performed and monitored regularly (for full-dose heparin)
• Use with caution if you have liver or kidney disease — these conditions slow heparin clearance and can raise drug levels in the blood
• Use with caution if you are over 60, especially if female — higher bleeding risk has been reported in this group
• Tell your doctor if you are pregnant — published data do not show increased birth defect risk, but animal studies showed increased pregnancy loss at high doses; discuss the risks and benefits with your provider
• Breastfeeding: heparin is unlikely to pass into breast milk, and would not be absorbed by a nursing infant if it did — discuss with your doctor
• Children: pediatric dosing is based on clinical experience, not controlled studies; close monitoring is essential
• Tell your care team if you have asthma or a known sulfite allergy — this product contains sodium metabisulfite
• Tell your doctor if you have diabetes, chronic kidney failure, or take potassium-sparing medications — higher risk of high potassium (hyperkalemia)

Too much heparin causes excessive bleeding. Early warning signs include easy bruising, tiny red spots on the skin (petechiae), nosebleeds, blood in the urine, or dark/tarry stools. If overdose is suspected, the heparin infusion should be stopped immediately. The antidote is protamine sulfate, a medication given slowly by IV that directly neutralizes heparin — but it carries its own risk of severe allergic reactions and must be given in a setting where emergency care is available.

Full therapeutic doses of heparin measurably prolong several blood clotting tests, including activated partial thromboplastin time (APTT) and whole blood clotting time — these tests are used to guide dosing. Low doses of heparin may not noticeably affect these tests. Heparin does not typically affect bleeding time. Patients over 60 may show longer APTTs compared to younger patients at the same dose, reflecting higher heparin levels in the blood.

Heparin cannot be absorbed through the digestive tract, so it must be given intravenously. When given by IV, it acts immediately. It binds extensively to proteins in the blood and has a small volume of distribution. Heparin is cleared mainly by the liver and certain immune cells; it is not broken down by enzymes. The half-life — how long it takes the body to clear half the drug — ranges from about 30 minutes to 2 hours, depending on the dose. People with kidney or liver disease, and adults over 60, may clear heparin more slowly and reach higher blood levels than others.

Avoid excessive heat. Protect from freezing. Store at 20°C to 25°C (68°F to 77°F).