Dosing and uses of Iprivask (desirudin)
Adult dosage forms and strengths
lyophilized powder for injection
- 15mg
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
Pediatric dosage forms and strengths
Safety and efficacy not established
Iprivask (desirudin) adverse (side) 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
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])
Pregnancy and 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.
Pharmacology of Iprivask (desirudin)
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%)
