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Heparin Lock Flush

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Overview

What is Heparin Lock Flush?

Heparin is a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans having anticoagulant properties. Although others may be present, the main sugars occurring in heparin are: (1) α-L-iduronic acid 2-sulfate, (2) 2-deoxy-2-sulfamino-α-D-glucose 6-sulfate, (3) ß-D-glucuronic acid, (4) 2-acetamido-2-deoxy-α-D-glucose and (5) α-L-iduronic acid.  These sugars are present in decreasing amounts, usually in the order (2)> (1)> (4)> (3)> (5), and are joined by glycosidic linkages, forming polymers of varying sizes.  Heparin is strongly acidic because of its content of covalently linked sulfate and carboxylic acid groups.  In heparin sodium, the acidic protons of the sulfate units are partially replaced by sodium ions.

Heparin Lock Flush Solution, USP is a sterile preparation of heparin sodium derived from porcine intestinal mucosa, standardized for anticoagulant activity, with sufficient sodium chloride to make it isotonic with blood.  The potency is determined by a biological assay using a USP reference standard based on units of heparin activity per milligram. 

Structure of Heparin Sodium (representative subunits):

 

Each mL contains: 10 USP Units Heparin sodium (porcine); 9 mg sodium chloride; Water for Injection q.s.  Sodium hydroxide and/or hydrochloric acid for pH adjustment (5.0-7.5).

Each mL contains: 100 USP Units Heparin sodium (porcine); 9 mg sodium chloride; Water for Injection q.s.  Sodium hydroxide and/or hydrochloric acid for pH adjustment (5.0-7.5).



What does Heparin Lock Flush look like?



What are the available doses of Heparin Lock Flush?

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What should I talk to my health care provider before I take Heparin Lock Flush?

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How should I use Heparin Lock Flush?

Heparin Lock Flush Solution, USP is intended to maintain patency of an indwelling venipuncture device designed for intermittent injection or infusion therapy or blood sampling.  Heparin lock flush solution may be used following initial placement of the device in the vein, after each injection of a medication or after withdrawal of blood for laboratory tests (see   for directions for use).

Heparin lock flush solution is not to be used for anticoagulant therapy.

Parental drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.  Slight discoloration does not alter potency.

Heparin Lock Flush Solution, USP (see ).


What interacts with Heparin Lock Flush?

Heparin sodium should NOT be used in patients with the following conditions: severe thrombocytopenia; an uncontrollable active bleeding state (see ), except when this is due to disseminated intravascular coagulation.



What are the warnings of Heparin Lock Flush?

Keep out of the reach of children.

Hypersensitivity

Patients with documented hypersensitivity to heparin should be given the drug only in clearly life-threatening situations (see ).

Hemorrhage

Hemorrhage 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 hemorrhagic event.

Heparin sodium should be used with extreme caution in infants and in patients with disease states in which there is increased danger of hemorrhage.  Some of the conditions in which increased danger of hemorrhage exists are:

Cardiovascular

Surgical

Hematologic

Gastrointestinal

Other

Thrombocytopenia

Thrombocytopenia has been reported to occur in patients receiving heparin with a reported incidence of 0 to 30%.  Platelet counts should be obtained at baseline.  Mild thrombocytopenia (count greater than 100,000/mm) may remain stable or reverse even if heparin is continued.  However, thrombocytopenia of any degree should be monitored closely.  If the count falls below 100,000/mmor if recurrent thrombosis develops (see Heparin-induced Thrombocytopenia and Heparin-induced Thrombocytopenia and Thrombosis), the heparin product should be discontinued and, if necessary, an alternative anticoagulant administered.

Heparin-induced Thrombocytopenia (HIT) and Heparin-induced Thrombocytopenia and Thrombosis (HITT)

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Delayed Onset of HIT and HITT

Heparin-induced Thrombocytopenia and Heparin-induced Thrombocytopenia and Thrombosis can occur up to several weeks after the discontinuation of heparin therapy.  Patients presenting with thrombocytopenia or thrombosis after discontinuation of heparin should be evaluated for HIT and HITT.

Use in Neonates

Preservative-Free Heparin Lock Flush Solution, USP should be used for maintaining the patency of intravenous injection devices in neonates.


What are the precautions of Heparin Lock Flush?

General

In infants, the cumulative amounts of heparin received from the frequent administration of Heparin Lock Flush Solution, USP during a 24- hour period should be considered.

Precautions must be exercised when drugs which are incompatible with heparin are administered through an indwelling intravenous catheter containing Heparin Lock Flush Solution, USP (see  ).

Thrombocytopenia, Heparin-induced Thrombocytopenia (HIT) and Heparin-induced Thrombocytopenia and Thrombosis (HITT)

See .

Increased Risk to Older Patients, Especially Women

Laboratory Tests

Periodic platelet counts, hematocrits and tests for occult blood in stool are recommended during the entire course of heparin use (see ).

Drug Interactions



Carcinogenesis, Mutagenesis, Impairment of Fertility

No long-term studies in animals have been performed to evaluate the carcinogenic potential of heparin.  Also, no reproduction studies in animals have been performed concerning mutagenesis or impairment of fertility.

Pregnancy



Nursing Mothers

Heparin is not excreted in human milk.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.  Not for use in neonates (see ).

Geriatric Use

A higher incidence of bleeding has been reported in patients over 60 years of age, especially women (see and ).


What are the side effects of Heparin Lock Flush?

Hemorrhage

Hemorrhage is the chief complication that may result from heparin use (see ).  An overly prolonged clotting time or minor bleeding during therapy can usually be controlled by withdrawing the drug (see ).

Thrombocytopenia, Heparin-induced Thrombocytopenia (HIT) and Heparin-induced Thrombocytopenia and Thrombosis (HITT) and Delayed Onset of HIT and HITT

See .

Local irritation and erythema have been reported with the use of heparin lock flush solution.

Hypersensitivity

Generalized hypersensitivity reactions have been reported, with chills, fever and urticaria as the most usual manifestations, and asthma, rhinitis, lacrimation, headache, nausea and vomiting, and anaphylactoid reactions, including shock, occurring more rarely.  Itching and burning, especially on the plantar side of the feet, may occur.

Thrombocytopenia has been reported to occur in patients receiving heparin, with a reported incidence of 0 to 30%.  While often mild and of no obvious clinical significance, such thrombocytopenia can be accompanied by severe thromboembolic complications such as skin necrosis, gangrene of the extremities that may lead to amputation, myocardial infarction, pulmonary embolism, stroke, and possibly death (see and ).

Certain episodes of painful, ischemic and cyanosed limbs have in the past been attributed to allergic vasospastic reactions.  Whether these are in fact identical to the thrombocytopenia-associated complications remains to be determined.


What should I look out for while using Heparin Lock Flush?

Heparin sodium should NOT be used in patients with the following conditions: severe thrombocytopenia; an uncontrollable active bleeding state (see ), except when this is due to disseminated intravascular coagulation.

Heparin is not intended for intramuscular use.


What might happen if I take too much Heparin Lock Flush?


How should I store and handle Heparin Lock Flush?

Store at 25°C (77°F); excursions permitted to 15–30°C (59–86°F) [see USP Controlled Room Temperature]. Protect from light. Keep bottles tightly closed to protect from moisture. It is recommended that the infusion bags be kept in the overwrap until ready to use. Protect infusion bags from freezing.Unused portion of the vial should be discarded.Use only if solution is clear and seal intact.Unused portion of the vial should be discarded.Use only if solution is clear and seal intact.


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Clinical Information

Chemical Structure

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Clinical Pharmacology

Heparin inhibits reactions that lead to the clotting of blood and the formation of fibrin clots both and .  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.  Once active thrombosis has developed, larger amounts of heparin can inhibit further coagulation by inactivating thrombin and preventing the conversion of fibrinogen to fibrin.  Heparin also prevents the formation of a stable fibrin clot by inhibiting the activation of the fibrin stabilizing factor.

Bleeding time is usually unaffected by heparin.  Clotting time is prolonged by full therapeutic doses of heparin; in most cases it is not measurably affected by low doses of heparin.  Loglinear plots of heparin plasma concentrations with time, for a wide range of dose levels, are linear, which suggests the absence of zero order processes.  Liver and the reticulo-endothelial system are the sites of biotransformation.  The biphasic elimination curve, a rapidly declining alpha phase (t= 10 minutes) and after the age of 40 a slower beta phase, indicates uptake in organs.  The absence of a relationship between anticoagulant half-life and concentration half-life may reflect factors such as protein binding of heparin.

Patients over 60 years of age, following similar doses of heparin, may have higher plasma levels of heparin and longer activated partial thromboplastine times (APTTs) compared with patients under 60 years of age.

Heparin does not have fibrinolytic activity; therefore, it will not lyse existing clots.

Non-Clinical Toxicology
Heparin sodium should NOT be used in patients with the following conditions: severe thrombocytopenia; an uncontrollable active bleeding state (see ), except when this is due to disseminated intravascular coagulation.

Heparin is not intended for intramuscular use.

In infants, the cumulative amounts of heparin received from the frequent administration of Heparin Lock Flush Solution, USP during a 24- hour period should be considered.

Precautions must be exercised when drugs which are incompatible with heparin are administered through an indwelling intravenous catheter containing Heparin Lock Flush Solution, USP (see  ).

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Professional

Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Tips

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Interactions

Interactions

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