Anticoagulants - parenteral

FONDAPARINUX ANTICOAGULANTS-PARENTERAL t risk of bleeding when heparins are given with fondaparinux Combined anticoagulant effect Manufacturers recommend avoiding co-administration 

Primary drug Secondary drug Effect Mechanism Precautions 

HEPARINS ALISKIREN Risk of hyperkalaemia with heparin Additive effect Monitor serum potassium closely 

HEPARINS ANALESICS - NSAIDs 1. Risk of prolonged bleeding when ketorolac is co-administered with dalteparin (but not enoxaparin), and intravenous diclofenac is given with heparins 2. t risk of hyperkalaemia when ketorolac is given with heparin 1. Uncertain 2. Heparin inhibits aldosterone secretion, causing hyperkalaemia 1. Avoid co-administration 2. Monitor potassium levels closely 

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ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS ANTICOAGULANTS -PARENTERAL T risk of hyperkalaemia with heparins Heparin inhibits aldosterone secretion, causing hyperkalaemia Monitor potassium levels closely... 

VASODILATOR ANTIHYPERTENSIVES ANTICOAGULANTS -PARENTERAL Possible t risk of bleeding with iloprost Anticoagulant effects of heparins t by a mechanism that is uncertain at present Monitor APTT closely... 

Anticoagulants Parenteral Heparin Enoxaparin Dalteparin, danaparoid, anti-thombin III... 

Parenteral Anticoagulant-induced prothrombin deficiency hypoprothrombinemia secondary to conditions limiting absorption or synthesis of vitamin K (eg, obstructive jaundice, biliary fistula, sprue, ulcerative colitis, celiac disease, intestinal resection, cystic fibrosis of the pancreas, regional enteritis) drug-induced hypoprothrombinemias due to interference with vitamin K metabolism (eg, antibiotics, salicylates) prophylaxis and therapy of hemorrhagic disease of the newborn. 

Inject subcutaneously or IM when possible. In older children and adults, inject IM in the upper outer quadrant of the buttocks. In infants and young children, the anterolateral aspect of the thigh or the deltoid region is preferred. When IV administration is unavoidable, inject very slowly, not exceeding 1 mg/min. Anticoagulant-induced prothrombin deficiency in adults 2.5 to 10 mg or up to 25 mg (rarely, 50 mg) initially. Determine subsequent doses by prothrombin time (PT) response or clinical condition. If in 6 to 8 hours after parenteral administration (or 12 to 48 hours after oral administration), the PT has not been shortened satisfactorily, repeat dose. If shock or excessive blood loss occurs, transfusion of blood or fresh frozen plasma may be required. 

Argatroban is intended for IV administration. Discontinue all parenteral anticoagulants before administration of argatroban. 

Epidural/Intrathecal- Presence of infection at the injection microinfusion site concomitant anticoagulant therapy uncontrolled bleeding diathesis parenterally administered corticosteroids within a 2-week period, other concomitant drug therapy or medical condition that would contraindicate the technique of epidural or intrathecal analgesia acute bronchial asthma upper airway obstruction. 

Drugs that may affect penicillins include allopurinol, aminoglycosides (parenteral), aspirin, beta blockers, chloramphenicol, erythromycin, ethacrynic acid, furosemide, indomethacin, phenylbutazone, probenecid, sulfonamides, tetracycline, and thiazide diuretics. Drugs that may be affected by penicillins include aminoglycosides (parenteral), anticoagulants, beta blockers, chloramphenicol, cyclosporine, oral contraceptives, erythromycin, heparin, and vecuronium. 

Heparin is prescribed on a unit (lU) rather than milligram basis. Tlie dose must be determined on an individual basis. Heparin is not absorbed after oral administration and therefore must be given parenterally. Intravenous administration results in an almost immediate anticoagulant effect. There is an approximate 2-hour delay in onset of drug action after subcutaneous administration. Intramuscular injection of heparin is to be avoided because of unpredictable absorption rates, local bleeding, and irritation. Heparin is not bound to plasma proteins or secreted into breast mUk, and it does not cross the placenta. 

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