Heparin sodium injectable
Heparin sodium guidance for curative and preventive anticoagulation, requiring coagulation monitoring and careful administration.
Therapeutic action
Anticoagulant.
By IV injection: acts immediately for about 2 to 4 hours.
SC injection: acts within 1 hour for about 8 to 12 hours.
Indications
- Curative treatment of venous and arterial thrombosis such as pulmonary embolism, myocardial infarction, and thrombophlebitis.
- Preventive treatment of venous and arterial thrombosis, especially in the pre-operative and postoperative period and in patients on bedrest.
Forms and strengths, route of administration
This drug should only be used by well trained personnel in well-equipped hospitals. During treatment, have protamine ready for use. Due to the narrow margin between therapeutic and toxic dose, coagulation parameters should be monitored.
- 1000 IU in 1 ml ampoule and 5000 IU in 1 ml ampoule for IV injection or infusion, diluted in an isotonic solution of glucose or sodium chloride.
- 25,000 IU in 1 ml ampoule for SC injection.
Dose
Curative treatment
- By IV route: child and adult, initial dose of 50 to 100 IU/kg followed by 400 to 600 IU/kg daily, by continuous infusion over 24 hours or by IV injection every 2 to 4 hours. Adjust dosage according to coagulation tests.
- By SC route: child and adult, 1 SC injection every 12 hours. Start with an initial dose of 250 IU/kg and adjust dosage according to coagulation tests.
Preventive treatment
- Usually 5000 IU by SC injection 2 hours before surgery, repeated every 8 to 12 hours.
- Dosage depends on the patient's weight and risk of thrombo-embolic complications: 75 IU/kg 2 times daily or 50 IU/kg 3 times daily.
Duration
About 7 to 10 days or more according to clinical response. In postoperative period, administer until fully ambulatory. For long-term therapy, administer heparin simultaneously with oral anticoagulants for 2 to 3 days before stopping heparin.
Contra-indications, adverse effects, precautions
- Do not administer in haemorrhage or risk of haemorrhage, thrombocytopenia, or history of heparin-induced thrombocytopenia.
- Do not administer by IM route. SC injections must be made deep into abdominal fat.
- Intramuscular or intra-arterial injections and infiltrations are contra-indicated during heparin therapy.
- May cause severe thrombocytopenia, localised reactions at the injection site, necrosis, allergic reactions, osteoporosis after prolonged use, alopecia, and haemorrhage in overdosage.
- Use with caution and reduce dosage in elderly patients and in hepatic or renal failure.
- Overdosage: neutralise heparin by slow IV injection of protamine.
- Monitor coagulation parameters and platelet count regularly.
- Avoid combination with aspirin and NSAIDs and closely monitor combinations with corticosteroids, dextran, and transition to an oral anticoagulant.
- Pregnancy: contraindicated at the end of pregnancy.
- Breast-feeding: no contra-indication.
- Do not mix with other drugs in the same syringe.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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