antithrombin III (Rx)

Brand and Other Names:Thrombate III
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 500 Units
  • 1000 Units

Therapeutic Goal

Prophylaxis of thrombosis during surgical or obstetrical procedures

Increase & maintain antithrombin activity between 80-120% (0.8-1.2 International Unit/mL) during treatment

Loading dose should target 100% AT activity level based on weight & pretreatment AT activity level

Determine Dosage on an Individual Basis

Base on pre-therapy plasma antithrombin III (AT-III) level

In order to increase plasma AT-III levels to that found in normal human plasma

Surgical Patients

Initial dose should raise AT levels to 120%

Load = [(120 - baseline AT activity level in %) x kg Body Weight]/1.4 = units of antithrombin required IV

Maintenance

  • Target subsequent dosing to keep levels between 80-120%, which may be achieved by administering 60% of initial loading dose q24hr
  • May adjust therapy by changing the dose or interval
  • Maintain target level for 2-8 days depending on type of procedure/situation

Heparin Resistance (Orphan)

Treatment of antithrombin III dependent heparin resistance requiring anticoagulation

Orphan indication sponsor

  • AT III LLC; c/o Genzyme Corporation,15 Pleasant St. Connector, P.O. Box 9322; Framingham, MA 01701

Safety & efficacy not established

Next:

Interactions

Interaction Checker

and antithrombin III

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (1)

            • mifepristone

              mifepristone, antithrombin III. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.

            Serious - Use Alternative (54)

            • abciximab

              antithrombin III, abciximab. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • amobarbital

              amobarbital decreases effects of antithrombin III by increasing metabolism. Avoid or Use Alternate Drug.

            • anagrelide

              antithrombin III, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • antithrombin alfa

              antithrombin alfa and antithrombin III both increase anticoagulation. Avoid or Use Alternate Drug.

            • argatroban

              antithrombin III and argatroban both increase anticoagulation. Avoid or Use Alternate Drug.

            • azithromycin

              azithromycin increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

            • bazedoxifene/conjugated estrogens

              bazedoxifene/conjugated estrogens decreases effects of antithrombin III by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • bemiparin

              antithrombin III and bemiparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • bivalirudin

              antithrombin III and bivalirudin both increase anticoagulation. Avoid or Use Alternate Drug.

            • butabarbital

              butabarbital decreases effects of antithrombin III by increasing metabolism. Avoid or Use Alternate Drug.

            • butalbital

              butalbital decreases effects of antithrombin III by increasing metabolism. Avoid or Use Alternate Drug.

            • cefamandole

              cefamandole increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cefazolin

              cefazolin increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cilostazol

              antithrombin III, cilostazol. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • clarithromycin

              clarithromycin increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

            • clopidogrel

              antithrombin III, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • conjugated estrogens

              conjugated estrogens decreases effects of antithrombin III by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • dabigatran

              antithrombin III and dabigatran both increase anticoagulation. Avoid or Use Alternate Drug. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • dalteparin

              antithrombin III and dalteparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • dipyridamole

              antithrombin III, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • enoxaparin

              antithrombin III and enoxaparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • eptifibatide

              antithrombin III, eptifibatide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • erythromycin base

              erythromycin base increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              erythromycin lactobionate increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin stearate

              erythromycin stearate increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

            • estradiol

              estradiol decreases effects of antithrombin III by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estrogens conjugated synthetic

              estrogens conjugated synthetic decreases effects of antithrombin III by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estropipate

              estropipate decreases effects of antithrombin III by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • Factor X, human

              antithrombin III 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.

            • fondaparinux

              antithrombin III and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • heparin

              antithrombin III and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • levonorgestrel intrauterine

              levonorgestrel intrauterine, antithrombin III. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levonorgestrel oral

              levonorgestrel oral, antithrombin III. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levothyroxine

              levothyroxine increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • liothyronine

              liothyronine increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • mestranol

              mestranol decreases effects of antithrombin III by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • pentobarbital

              pentobarbital decreases effects of antithrombin III by increasing metabolism. Avoid or Use Alternate Drug.

            • phenindione

              antithrombin III and phenindione both increase anticoagulation. Avoid or Use Alternate Drug.

            • phenobarbital

              phenobarbital decreases effects of antithrombin III by increasing metabolism. Avoid or Use Alternate Drug.

            • piperacillin

              piperacillin increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • primidone

              primidone decreases effects of antithrombin III by increasing metabolism. Avoid or Use Alternate Drug.

            • protamine

              antithrombin III and protamine both increase anticoagulation. Avoid or Use Alternate Drug.

            • quinine

              quinine increases effects of antithrombin III by unknown mechanism. Avoid or Use Alternate Drug.

            • roxithromycin

              roxithromycin increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

            • secobarbital

              secobarbital decreases effects of antithrombin III by increasing metabolism. Avoid or Use Alternate Drug.

            • sulfadiazine

              sulfadiazine increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfadiazine increases effects of antithrombin III by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfamethoxazole

              sulfamethoxazole increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfamethoxazole increases effects of antithrombin III by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfisoxazole

              sulfisoxazole increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfisoxazole increases effects of antithrombin III by plasma protein binding competition. Avoid or Use Alternate Drug.

            • thyroid desiccated

              thyroid desiccated increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • tibolone

              tibolone increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • ticlopidine

              antithrombin III, ticlopidine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • tirofiban

              antithrombin III, tirofiban. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • warfarin

              antithrombin III and warfarin both increase anticoagulation. Avoid or Use Alternate Drug.

            Monitor Closely (117)

            • aceclofenac

              antithrombin III and aceclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • acemetacin

              antithrombin III and acemetacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • agrimony

              antithrombin III and agrimony both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alfalfa

              antithrombin III and alfalfa both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alteplase

              antithrombin III and alteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • American ginseng

              antithrombin III and American ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • anamu

              antithrombin III and anamu both increase anticoagulation. Use Caution/Monitor.

            • aspirin

              antithrombin III and aspirin both increase anticoagulation. Modify Therapy/Monitor Closely.

              aspirin, antithrombin III. Either increases toxicity of the other by anticoagulation. 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 rectal

              antithrombin III and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, antithrombin III. Either increases toxicity of the other by anticoagulation. 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.

              antithrombin III and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • azapropazone

              azapropazone increases effects of antithrombin III by plasma protein binding competition. Use Caution/Monitor.

            • azathioprine

              azathioprine decreases effects of antithrombin III by unknown mechanism. Use Caution/Monitor.

            • azficel-T

              azficel-T, antithrombin III. 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

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

            • budesonide

              budesonide, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • capecitabine

              capecitabine increases effects of antithrombin III by unspecified interaction mechanism. Use Caution/Monitor.

            • caplacizumab

              caplacizumab, antithrombin III. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • carbamazepine

              carbamazepine decreases levels of antithrombin III by increasing metabolism. Use Caution/Monitor.

            • celecoxib

              antithrombin III and celecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • chitosan

              chitosan increases effects of antithrombin III by Other (see comment). Use Caution/Monitor. Comment: Chitosan can decrease GI absorption of vitamin K, enhancing anticoagulant effects.

            • choline magnesium trisalicylate

              antithrombin III and choline magnesium trisalicylate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cinnamon

              antithrombin III and cinnamon both increase anticoagulation. Modify Therapy/Monitor Closely.

            • citalopram

              citalopram increases effects of antithrombin III by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

            • collagenase clostridium histolyticum

              antithrombin III 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).

            • conjugated estrogens, vaginal

              conjugated estrogens, vaginal decreases effects of antithrombin III by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Risk of thromboembolic disorders.

            • cordyceps

              antithrombin III and cordyceps both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cornsilk

              cornsilk decreases effects of antithrombin III by pharmacodynamic antagonism. Use Caution/Monitor. Cornsilk contains vitamin K; consume a consistent amount daily.

            • cortisone

              cortisone, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • cyclophosphamide

              cyclophosphamide increases effects of antithrombin III by unknown mechanism. Use Caution/Monitor.

            • danshen

              antithrombin III and danshen both increase anticoagulation. Use Caution/Monitor.

            • deferasirox

              deferasirox, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.

            • deflazacort

              deflazacort, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • devil's claw

              antithrombin III and devil's claw both increase anticoagulation. Use Caution/Monitor.

            • dexamethasone

              dexamethasone, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • diclofenac

              antithrombin III and diclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • diflunisal

              antithrombin III and diflunisal both increase anticoagulation. Modify Therapy/Monitor Closely.

              diflunisal increases effects of antithrombin III by plasma protein binding competition. Use Caution/Monitor.

            • dong quai

              antithrombin III and dong quai both increase anticoagulation. Modify Therapy/Monitor Closely.

            • epoprostenol

              antithrombin III and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ethanol

              ethanol increases effects of antithrombin III by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

            • ethotoin

              antithrombin III increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • etodolac

              antithrombin III and etodolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenbufen

              antithrombin III and fenbufen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fennel

              antithrombin III and fennel both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenoprofen

              antithrombin III and fenoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • feverfew

              antithrombin III and feverfew both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fish oil

              fish oil, antithrombin III. 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. 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 antithrombin III 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.

            • fludrocortisone

              fludrocortisone, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • fluorouracil

              fluorouracil increases effects of antithrombin III by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of fluorouracil, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • flurbiprofen

              antithrombin III and flurbiprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • forskolin

              antithrombin III and forskolin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fosphenytoin

              antithrombin III increases levels of fosphenytoin by unknown mechanism. Use Caution/Monitor.

              fosphenytoin, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • garlic

              antithrombin III and garlic both increase anticoagulation. Modify Therapy/Monitor Closely.

            • gemcitabine

              gemcitabine increases effects of antithrombin III by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of gemcitabine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • ginger

              antithrombin III and ginger both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginkgo biloba

              antithrombin III and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

            • glucagon intranasal

              glucagon intranasal increases effects of antithrombin III by unknown mechanism. Use Caution/Monitor.

            • green tea

              green tea, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding, caution is advised.

            • heparin

              antithrombin III increases effects of heparin by pharmacodynamic synergism. Use Caution/Monitor. Use reduced dose of heparin during antithrombin III therapy to avoid bleeding.

            • horse chestnut seed

              antithrombin III and horse chestnut seed both increase anticoagulation. Modify Therapy/Monitor Closely.

            • hydrocortisone

              hydrocortisone, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • ibrutinib

              ibrutinib will increase the level or effect of antithrombin III 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.

            • ibuprofen

              antithrombin III and ibuprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ibuprofen IV

              antithrombin III and ibuprofen IV both increase anticoagulation. Modify Therapy/Monitor Closely.

            • icosapent

              icosapent, antithrombin III. 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.

            • indomethacin

              antithrombin III and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • iodine (radioactive)

              iodine (radioactive) decreases effects of antithrombin III by pharmacodynamic antagonism. Use Caution/Monitor.

            • ketoprofen

              antithrombin III and ketoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac

              antithrombin III and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac intranasal

              antithrombin III and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • lofepramine

              lofepramine increases levels of antithrombin III by decreasing metabolism. Use Caution/Monitor.

            • lornoxicam

              antithrombin III and lornoxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • meclofenamate

              antithrombin III and meclofenamate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • mefenamic acid

              antithrombin III and mefenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • melatonin

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

            • meloxicam

              antithrombin III and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • methimazole

              methimazole decreases effects of antithrombin III by pharmacodynamic antagonism. Use Caution/Monitor.

            • methylprednisolone

              methylprednisolone, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • mistletoe

              antithrombin III increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nabumetone

              antithrombin III and nabumetone both increase anticoagulation. Modify Therapy/Monitor Closely.

            • naproxen

              antithrombin III and naproxen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • nettle

              antithrombin III increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, antithrombin III. 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, antithrombin III. 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. .

            • oxaprozin

              antithrombin III and oxaprozin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • panax ginseng

              antithrombin III and panax ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • parecoxib

              antithrombin III and parecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pau d'arco

              antithrombin III and pau d'arco both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pegaspargase

              pegaspargase increases effects of antithrombin III by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.

            • phenytoin

              antithrombin III increases levels of phenytoin by unknown mechanism. Use Caution/Monitor.

              phenytoin, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • phytoestrogens

              antithrombin III and phytoestrogens both increase anticoagulation. Modify Therapy/Monitor Closely.

            • piroxicam

              antithrombin III and piroxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • porfimer

              antithrombin III decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.

            • prasugrel

              antithrombin III, prasugrel. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced risk of hemorrhage.

            • prednisolone

              prednisolone, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • prednisone

              prednisone, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • propafenone

              propafenone increases effects of antithrombin III by decreasing metabolism. Use Caution/Monitor.

            • propylthiouracil

              propylthiouracil decreases effects of antithrombin III by pharmacodynamic antagonism. Use Caution/Monitor.

            • reishi

              antithrombin III and reishi both increase anticoagulation. Modify Therapy/Monitor Closely.

            • reteplase

              antithrombin III and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • rifabutin

              rifabutin decreases levels of antithrombin III by increasing metabolism. Use Caution/Monitor.

            • rivaroxaban

              rivaroxaban, antithrombin III. 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.

            • salicylates (non-asa)

              antithrombin III and salicylates (non-asa) both increase anticoagulation. Modify Therapy/Monitor Closely.

            • salsalate

              antithrombin III and salsalate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • Siberian ginseng

              antithrombin III and Siberian ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulfasalazine

              antithrombin III and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulindac

              antithrombin III and sulindac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • tenecteplase

              antithrombin III and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ticagrelor

              ticagrelor, antithrombin III. 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.

            • tipranavir

              tipranavir increases effects of antithrombin III by pharmacodynamic synergism. Use Caution/Monitor. Tipranavir has mild antiplatelet activity that may incr bleeding risk.

            • tolfenamic acid

              antithrombin III and tolfenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • tolmetin

              antithrombin III and tolmetin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • triclofos

              triclofos increases effects of antithrombin III by unspecified interaction mechanism. Use Caution/Monitor.

            • vorapaxar

              antithrombin III, 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

              vortioxetine and antithrombin III both increase anticoagulation. Use Caution/Monitor.

            • zanubrutinib

              antithrombin III, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            Minor (17)

            • acetaminophen

              acetaminophen increases effects of antithrombin III by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen IV

              acetaminophen IV increases effects of antithrombin III by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen rectal

              acetaminophen rectal increases effects of antithrombin III by unknown mechanism. Minor/Significance Unknown.

            • alprostadil intracavernous/urethral

              alprostadil intracavernous/urethral increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • ceftaroline

              ceftaroline increases effects of antithrombin III by Other (see comment). Minor/Significance Unknown. Comment: Cephalosporins with a methylthiotetrazole (MTT) side ring (eg, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity.

            • chlorella

              chlorella decreases effects of antithrombin III by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical, due to vitamin K content.

            • demeclocycline

              demeclocycline increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • dexmethylphenidate

              dexmethylphenidate increases effects of antithrombin III by decreasing metabolism. Minor/Significance Unknown.

            • doxycycline

              doxycycline increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • glyburide

              glyburide increases effects of antithrombin III by unspecified interaction mechanism. Minor/Significance Unknown.

            • mineral oil

              mineral oil decreases levels of antithrombin III by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • minocycline

              minocycline increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • oxytetracycline

              oxytetracycline increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • quinidine

              quinidine increases effects of antithrombin III by decreasing metabolism. Minor/Significance Unknown.

            • tetracycline

              tetracycline increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • verteporfin

              antithrombin III decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • vitamin E

              vitamin E, antithrombin III. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Vitamin E at RDA does not change INR in pts. on chronic warfarin therapy; megadoses (~10x RDA) may enhance anticoagulant effects in vitamin K deficient pts.

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            Adverse Effects

            1-10%

            Dizziness (7%)

            Chest pain (≤2%)

            Hemorrhage (≥5%)

            Hematoma (≤2%)

            Liver enzyme abnormalities (≤2%)

            Hematuria (≤2%)

            Hemarthrosis (≤2%)

            Infusion site reaction (≥5%)

            <1%

            Bowel fullness

            Chills

            Cramps

            Dysgeusia

            Dyspnea

            Hives

            Fever

            Foul taste

            Film over eye

            Lightheadedness

            Nausea

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            Warnings

            Contraindications

            None listed in the FDA approved manufacturing labeling

            Cautions

            Hypersensitivity, including anaphylactic reactions my occur; monitor closely; discontinue immediately and administer appropriate care if symptoms occur

            Theoretical risk of blood-borne pathogens as it is a plasma product; risk is reduced by screening of donors and testing and/or inactivation or removal of viruses; report to manufacturer infections suspected from product

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Not known if distributed into breast milk, use caution

            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

            Serine protease inhibitor; important natural inhibitor of blood coagulation; inactivation of thrombin, plasmin, and other active serine proteases of coagulation including factors IXa, Xa, XIa, and XIIa.

            Pharmacokinetics

            Half-life: 2.5-3.8 days; surgery, acute thrombosis, and/or concomitant heparin may shorten half-life

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            Administration

            IV Preparation

            Reconstitute aseptically w/ SWI (supplied: 10 mL for 500 U & 20 mL for 1000 U)

            Bring to room temperature prior to administration

            Administer within 3 hr after reconstitution; do not refrigerate after reconstitution

            Contents of multiple vials may be drawn into same syringe through filter needles provided, if patient needs more than one vial

            IV Administration

            Administer within 3 hr after reconstitution

            Rate of administration should be adapted to response of patient; generally infusion over 10-20 min well tolerated

            Storage

            Room temp upto 25°C (77°F)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Thrombate III intravenous
            -
            500 (+/-) unit vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            antithrombin III (human) intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            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.
            • Manage and view all your plans together – even plans in different states.
            • 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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.