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Desirudin (Subcutaneous route)

Pronunciation:

des-i-ROO-din

Brand Names:

  • Iprivask

Dosage Forms:

  • Powder for Solution

Warnings:

Subcutaneous route(Powder for Solution)

Epidural or spinal hematomas, which may result in long-term or permanent paralysis, may occur in patients who are anticoagulated with selective thrombin inhibitors and are undergoing neuraxial anesthesia or spinal puncture. The risk of developing these hematomas is increased with the use of indwelling epidural catheters and concomitant use of drugs affecting hemostasis. Monitor patients frequently for neurological impairment and treat immediately if neurological compromise is noted. Consider risks/benefits before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis .

Classifications:

Therapeutic—

Anticoagulant

Pharmacologic—

Thrombin Inhibitor, Direct

Chemical—

Hirudin Related

Uses of This Medicine:

Desirudin is used to prevent deep venous thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs. These blood clots can travel to the lungs and can become lodged in the blood vessels of the lungs, causing a condition called pulmonary embolism. This medicine is used for several days after hip replacement surgery, while you are unable to walk. It is during this time that blood clots are most likely to form.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of desirudin in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of desirudin in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving desirudin.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abciximab
  • Aceclofenac
  • Acemetacin
  • Alipogene Tiparvovec
  • Alteplase, Recombinant
  • Amtolmetin Guacil
  • Anistreplase
  • Apixaban
  • Aspirin
  • Bromfenac
  • Bufexamac
  • Celecoxib
  • Chamomile
  • Choline Salicylate
  • Cilostazol
  • Citalopram
  • Clonixin
  • Clopidogrel
  • Collagenase, Clostridium histolyticum
  • Dabigatran Etexilate
  • Desvenlafaxine
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Eptifibatide
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenofibrate
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Garlic
  • Ginkgo
  • Ibuprofen
  • Ibuprofen Lysine
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Levomilnacipran
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Milnacipran
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxyphenbutazone
  • Papaya
  • Parecoxib
  • Paroxetine
  • Pentosan Polysulfate Sodium
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pranoprofen
  • Prasugrel
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Reteplase, Recombinant
  • Rivaroxaban
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sodium Salicylate
  • St John's Wort
  • Streptokinase
  • Sulfinpyrazone
  • Sulindac
  • Tan-Shen
  • Tenecteplase
  • Tenoxicam
  • Tiaprofenic Acid
  • Ticlopidine
  • Tirofiban
  • Tolfenamic Acid
  • Tolmetin
  • Urokinase
  • Valdecoxib
  • Venlafaxine
  • Vortioxetine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Avocado
  • Chondroitin
  • Coenzyme Q10
  • Curcumin
  • Dong Quai
  • Ginger
  • Vitamin A

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Blood clotting disorders or
  • Major bleeding, active—Should not be used in patients with these conditions.
  • Blood disease or bleeding problems (e.g., hemophilia) or
  • Catheter insertion in your spine or
  • Eye problems caused by diabetes or
  • Heart infection (e.g., bacterial endocarditis) or
  • Hypertension (high blood pressure), severe and uncontrolled or
  • Liver disease or
  • Major surgery procedure (e.g., organ biopsy), recent or history of or
  • Stomach or intestinal ulcer, history of or
  • Stroke, recent or history of or
  • Surgery (e.g., surgery of the eye, brain, or spine), recent or history of—Use with caution. The risk of bleeding may be increased.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal from the body.

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine. This medicine is given as a shot under your skin, usually in the abdomen or thighs.

If you are using desirudin at home, your doctor will teach you how to inject yourself with the medicine. Be sure to follow the directions carefully. Check with your doctor if you have any problems using the medicine.

You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas. This will help prevent skin problems from the injections.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

If the medicine in the vial (glass container) or prefilled syringe has changed color, or if you see particles in it, do not use it.

Put used syringes in a puncture-resistant, disposable container, or dispose of them as directed by your doctor.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form:
    • For prevention of deep venous thrombosis (leg clots) after hip replacement surgery:
      • Adults—15 milligrams (mg) injected under the skin every 12 hours. The dose is 1.7 to 5 mg every 12 hours if you have a poorly performing kidney.
      • Children—Use and dose must be determined by your doctor.

Missed dose—

Call your doctor or pharmacist for instructions.

Storage—

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the unopened vials or prefilled syringes at room temperature, away from heat, moisture, and direct light. You may also store the mixed solution at room temperature and may be used up to 24 hours. Throw away any unused medicine after 24 hours.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests will be needed to check for unwanted effects. Be sure to keep all appointments.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash; itching; swelling of the face, tongue, and throat; trouble breathing; or chest pain after you receive this medicine.

Make sure your doctor knows if you have had an allergic reaction to similar medicines such as bivalirudin, lepirudin, Angiomax®, Angiox®, or Refludan®.

Desirudin may increase your chance of bleeding or bruising. This risk is higher if you have a catheter in your back for pain medicine or anesthesia (sometimes called an "epidural"), or if you have kidney problems. The risk of bleeding increases as the severity of your kidney problems increases. Check with your doctor right away if you notice any unusual bleeding or bruising; black, tarry stools; bleeding gums; blood in the urine or stools; or pinpoint red spots on your skin.

You may bleed and bruise more easily while you are using this medicine. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Be careful when using sharp objects, including razors and fingernail clippers. Avoid nose picking and forceful nose blowing.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using desirudin several days before having surgery or medical tests.

Do not take or discontinue other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines, and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
Bleeding gums
collection of blood under the skin
coughing up blood
deep, dark purple bruise
difficulty with breathing or swallowing
dizziness
headache
increased menstrual flow or vaginal bleeding
itching, pain, redness, or swelling
nosebleeds
paralysis
prolonged bleeding from cuts
red or black, tarry stools
red or dark brown urine
shortness of breath
Less common
Changes in skin color, pain, tenderness, or swelling of the foot or leg
cough
fast heartbeat
hives
pale skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
skin rash
tightness in the chest
troubled breathing with exertion
unusual bleeding or bruising
unusual tiredness or weakness
wheezing
wound secretion
Less common or rare
Blood in the urine
blurred vision
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fever
severe or sudden headache
sudden loss of coordination
sudden slurring of speech
sweating
tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over affected area
trouble healing
vomiting of blood or material that looks like coffee grounds

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
Nausea
vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 4/4/2014

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