desirudin (Discontinued)

Brand and Other Names:Iprivask
  • Print

Dosing & Uses

AdultPediatric

Product discontinued in United States

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and desirudin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (1)

            • defibrotide

              desirudin increases effects of defibrotide by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

            Serious - Use Alternative (3)

            • apixaban

              desirudin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • Factor X, human

              desirudin will decrease the level or effect of Factor X, human by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors.

            • vortioxetine

              vortioxetine and desirudin both increase anticoagulation. Avoid or Use Alternate Drug.

            Monitor Closely (19)

            • aspirin

              aspirin, desirudin. Either increases levels of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, desirudin. Either increases levels of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • azficel-T

              azficel-T, desirudin. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

            • betrixaban

              desirudin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • collagenase clostridium histolyticum

              desirudin increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).

            • dabigatran

              dabigatran and desirudin both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • fish oil

              fish oil, desirudin. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of desirudin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • green tea

              green tea, desirudin. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

            • ibrutinib

              ibrutinib will increase the level or effect of desirudin by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • icosapent

              icosapent, desirudin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

            • melatonin

              melatonin increases effects of desirudin by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, desirudin. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • omega 3 fatty acids

              omega 3 fatty acids, desirudin. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • rivaroxaban

              rivaroxaban, desirudin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • saw palmetto

              saw palmetto increases toxicity of desirudin by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

            • ticagrelor

              ticagrelor, desirudin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

            • vorapaxar

              desirudin, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • vortioxetine

              desirudin, vortioxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor.

            Minor (0)

              Previous
              Next:

              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

              Previous
              Next:

              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])

              Previous
              Next:

              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.

              Previous
              Next:

              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%)

              Previous
              Next:

              Images

              No images available for this drug.
              Previous
              Next:

              Patient Handout

              A Patient Handout is not currently available for this monograph.
              Previous
              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.