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desirudin (Rx)Brand and Other Names:Iprivask

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lyophilized powder for injection

  • 15mg
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Deep Vein Thrombosis Prevention

Indicated for prophylaxis of DVT in patients undergoing elective hip replacement surgery

15 mg SC q12hr; initiate 5-15 min before surgery (but after induction of regional block anesthesia) and continue for 9-12 days

Administration

Administer by deep SC injection into anterolateral or posterolateral thigh or abdominal wall

Rotate injection sites

Do not mix with other injection, solvents, infusion

Renal Impairment

CrCl 31-60 mL/min/1.73 m²: Initiate with 5 mg SC q12hr

CrCl <31 mL/min/1.73 m²: Initiate with 1.7 mg SC q12hr

Severe renal impairment may prolong half-life (up to 12 hr)

Adjust dose in relation to degree of renal impairment or aPTT abnormality

Safety and efficacy not established

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Interactions

Interaction Checker

desirudin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Hemorrhage (1-3%)

            Injection site mass (4%)

            Wound secretion (4%)

            Serious hemorrhage (3%)

            Anemia (3%)

            Deep thrombophlebitis (2%)

            Nausea (2%)

            Allergic reaction (2%)

            <1%

            Major hemorrhage

            Hypotension

            Leg edema

            Fever

            Decreased hemoglobin

            Hematuria

            Dizziness

            Epistaxis

            Vomiting

            Impaired healing

            Cerebrovascular disorder

            Leg pain

            Hematemesis

            Hematuria

            Leg edema

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            Warnings

            Black Box Warnings

            Epidural or spinal hematomas may occur if receiving neuraxial anesthesia (ie, epidural/spinal anesthesia) or with spinal puncture

            These hematomas may result in long-term or permanent paralysis

            When scheduling patient for spinal procedures, thoroughly evaluate risk and consider other forms of anesthesia

            Risk Factors

            • Indwelling epidural catheters
            • Coadministration with drugs that affect hemostasis (eg, NSAIDs, platelet inhibitors, other anticoagulants)
            • History of traumatic or repeated epidural or spinal punctures
            • History of spinal deformity or spinal surgery

            Monitor for signs and symptoms of neurological impairment; urgent treatment required if neurologic compromise observed

            Contraindications

            Hypersensitivity

            Active bleeding or irreversible coagulation disorders

            Cautions

            Renal impairment (decrease dose)

            Increased hemorrhage risk (eg, recent surgery, biopsy, major vessel venipuncture, hemorrhagic stroke, retinopathy, GI bleed)

            Spinal or epidural anesthesia

            Advanced age (>75 years)

            May develop antibodies with reexposure

            Prolongs thrombin-dependent coagulation assays (eg, aPTT, thrombin time [TT])

            Any agent which may enhance the risk of hemorrhage should be discontinued prior to initiation of desirudin therapy (eg, Dextran 40, systemic glucocorticoids, thrombolytics, and anticoagulants)

            Caution when coadministered with drugs that affect platelet function (eg, salicylates, NSAIDS, acetylsalicylic acid, ticlopidine, dipyridamole, sulfinpyrazone, clopidogrel, and glycoprotein IIb/IIIa antagonists [eg, abciximab])

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Unknown whether distributed in breast milk, caution advised

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Recombinant hirudin product; selective inhibitor of free circulating and clot-bound human thrombin, with protein structures similar to naturally occurring hirudin (an anticoagulant present in medicinal leeches)

            Inhibits activation of thrombin-induced platelet aggregation, coagulation factors V, VII, and XIII, which in turn results in prolongation of the activated partial thromboplastin time

            Pharmacokinetics

            Half-Life: 2-4 hr

            Vd: 25 L/kg

            Peak Plasma Time: 1-3 hr  

            Clearance: 1.5-2.7 mL/min/kg

            Excretion: Unchanged in urine (40-50%)  

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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