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Heparin Sodium Injection, USP
Rx only
DESCRIPTION
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)
β-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.
Structural formula of Heparin Sodium (representative sub-units):
Heparin Sodium Injection, USP is a sterile solution of heparin sodium derived from porcine intestinal
mucosa, standardized for anticoagulant activity. It is to be administered by intravenous or deep
subcutaneous routes. The potency is determined by a biological assay using a USP reference standard
based on units of heparin activity per milligram.
Heparin Sodium Injection, USP is available in the following concentrations/mL:
Heparin
Sodium
Sodium Chloride Benzyl
Alcohol
1000
USP units
8.6 mg
0.01 mL
5000 USP units
7 mg
0.01 mL
10,000 USP units
5 mg
0.01 mL
pH 5.0-7.5; sodium hydroxide and/or hydrochloric acid added, if needed, for pH adjustment.
CLINICAL PHARMACOLOGY
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. 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.
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Patients over 60 years of age, following similar doses of heparin, may have higher
plasma levels of
heparin and longer activated partial thromboplastin times (APTTs) compared with patients under 60
years of age.
Peak plasma levels of heparin are achieved 2 to 4 hours following subcutaneous administration,
although there are considerable individual variations. 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 reticuloendothelial system are the sites of biotransformation. The biphasic
elimination curve, a rapidly declining alpha phase (t
1/2
=10 min.) 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.
Heparin does not have fibrinolytic activity; therefore, it will not lyse existing clots.