A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Heparin Side Effects, and Drug Interactions - Heparin
Heparin Side Effects, and Drug Interactions - Heparin
SIDE EFFECTS
Hemorrhage
Hemorrhage is the chief complication
that may result from heparin
sodium therapy (see WARNINGS).
An overly prolonged clotting
time or minor
bleeding during therapy
can usually be controlled by withdrawing the drug
(see OVERDOSAGE). It should
be appreciated that gastrointestinal
or urinary tract
bleeding during anticoagulant
therapy may indicate
the presence of an underlying occult lesion. Bleeding can occur
at any site but certain
specific hemorrhagic
complications may be difficult to detect:
(a) Adrenal hemorrhage,
with resultant acute adrenal
insufficiency, has occurred during anticoagulant
therapy. Therefore, such
treatment should be
discontinued in patients who develop signs and symptoms of acute
adrenal hemorrhage and insufficiency. Initiation of corrective
therapy should not depend
on laboratory confirmation
of the diagnosis,
since delay in an acute situation may result in the patient's death.
(b) Ovarian (corpus luteum) hemorrhage
developed in a number
of women of reproductive
age a receiving short- or
long- term anticoagulant
therapy. This complication, if unrecognized, may be fatal.
(c) Retroperitoneal hemorrhage.
Local Irritation
Local irritation, erythema,
mild pain, hematoma
or ulceration may
follow deep subcutaneous
(intrafat) injection
of heparin sodium. These
complications are much more common after intramuscular
use, and such use is not
recommended.
Hypersensitivity
Generalized hypersensitivity
reactions have been reported, with chills, fever and urticaria
as the most usual manifestations, and asthma,
rhinitis, lacrimation, headache,
nausea and vomiting,
and anaphylactoid reactions, including shock, occurring more rarely.
Itching and burning, especially on the plantar
site of the feet, may occur.
Thrombocytopenia has been reported to occur in patients receiving
heparin sodium
with a reported incidence of 0 to 30%. While often mild and of no
obvious clinical significance,
such thrombocytopenia
can be accompanied by severe thromboembolic complications such as
skin necrosis,
gangrene of the extremities
that may lead to amputation,
myocardial infarction, pulmonay embolism,
stroke and possibly death.(
See WARNINGS and PRECAUTIONS.)
Certain episodes of painful, ischemic and cyanosed
limbs have in the past been attributed to allergic
vasospastic reactions.
Whether these are in fact identical
to the thrombocytopenia-associated complications remains to be determined.
Miscellaneous
Osteoporosis following long-term administration
of high-doses of heparin sodium, cutaneous
necrosis after systemic
administration, suppression
of aldosterone synthesis, delayed transient
alopecia, priapism
and rebound hyperlipemia on discontinuation of heparin
sodium have also been
reported. Significant evaluations of aminotransferase (SGOT [S-AST]
and SGPT [S-ALT]) levels
have occurred in a high percentage of patients (and healthy
subjects) who have received heparin
sodium.
DRUG INTERACTIONS
Oral Anticoagulants
Heparin sodium may prolong
the one-stage prothrombin
time. Therefore, when heparin
sodium is given with
dicumarol or warfarin
sodium, a period of at
least five hours after the last intravenous
dose or 24 hours after
the last subcutaneous
dose should elapse before
blood is drawn if a valid
prothrombin time is to
be obtained.
Platelet Inhibitors
Drugs such as acetylsalicylic
acid, dextran, phenylbutazone,
ibuprofen, indomethacin, dipyridamole, hydroxychloroquine and others
that interfere with platelet-aggregation reactions (the main
hemostatic defense
of heparinized patients) may induce bleeding
and should be used with caution in patients receiving heparin
sodium.
Other Interactions
Digitalis, tetracyclines, nicotine
or antihistamines may partially counteract the anticoagulant
action of heparin
sodium.
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