Iprivask (desirudin) dosing, indications, interactions, adverse effects, and more.

Sections

Sections desirudin
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout

Dosing & Uses

AdultPediatric

Product discontinued in United States

Safety and efficacy not established

Interaction Checker

Enter a drug name and desirudin

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No Interactions Found

Interactions Found

Contraindicated

Serious - Use Alternative

Significant - Monitor Closely

Minor

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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)

apixaban
Serious - Use Alternative (1)desirudin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.
aspirin
Monitor Closely (1)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
Monitor Closely (1)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
Monitor Closely (1)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
Monitor Closely (1)desirudin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.
collagenase clostridium histolyticum
Monitor Closely (1)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
Monitor Closely (1)dabigatran and desirudin both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
defibrotide
Contraindicated (1)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.
Factor X, human
Serious - Use Alternative (1)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.
fish oil
Monitor Closely (1)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
Monitor Closely (1)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
Monitor Closely (1)green tea, desirudin. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.
ibrutinib
Monitor Closely (1)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
Monitor Closely (1)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
Monitor Closely (1)melatonin increases effects of desirudin by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.
omega 3 carboxylic acids
Monitor Closely (1)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
Monitor Closely (1)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
Monitor Closely (1)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
Monitor Closely (1)saw palmetto increases toxicity of desirudin by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.
ticagrelor
Monitor Closely (1)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
Monitor Closely (1)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
Monitor Closely (1)desirudin, vortioxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor.Serious - Use Alternative (1)vortioxetine and desirudin both increase anticoagulation. Avoid or Use Alternate Drug.

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

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])

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.

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%)

Images

No images available for this drug.

Patient Handout

A Patient Handout is not currently available for this monograph.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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