Desirudin (Iprivask) is a direct thrombin inhibitor that is indicated for the prevention of deep vein thrombosis in patients undergoing hip replacement surgery.
Desirudin (Iprivask) Uses:
- Prophylaxis of Deep vein thrombosis:
- It is indicated for the prophylaxis of deep vein thrombosis in patients who undergo hip-replacement surgery.
Desirudin (Iprivask) Dose in Adults
Note:
- When used for surgical prophylaxis, the drug may be administered 5 - 15 minutes before surgery and after the induction of regional anaesthesia.
- The drug may be administered for up to 12 days.
Desirudin (Iprivask) Dose in the prophylaxis of DVT:
- 15 mg subQ twice daily.
- The treatment may need interruption if the aPTT exceeds twice the control.
- It should be resumed at a lower dose based on the degree of aPTT abnormality and when the aPTT is less than twice the control.
Use in Children:
Not indicated.
Pregnancy Risk Factor C
- Animal reproduction studies have shown adverse outcomes for fetuses.
- There are insufficient data on the use of thrombin inhibitors during pregnancy.
Desirudin use during breastfeeding:
- It is unknown if the drug will be excreted into breastmilk.
- Manufacturers recommend that you stop breastfeeding.
- It is important that you note that although the drug can be excreted in breastmilk it has very little enteral absorption.
- According to some references, the drug can be continued while breastfeeding is being done.
Desirudin (Iprivask) Dose in Kidney Disease:
- Moderate impairment (CrCl ≥31 to 60 mL/minute/1.73 m²):
- Initial dose:
- 5 mg twice daily.
- If the aPTT exceeds twice the control, treatment must be interrupted;
- The dose should then be resumed at a lower dose when the aPTT is less than twice the normal.
- Initial dose:
- Severe impairment (CrCl <31 mL/minute/1.73 m²):
- Initial dose:
- 1.7 mg twice daily.
- If the aPTT exceeds twice the control, treatment must be interrupted.
- The dose should be resumed at a lower dose when the aPTT is lower than twice the control.
- Initial dose:
- Hemodialysis:
- Dialyzable: Yes
Desirudin (Iprivask) Dose in Liver disease:
- It should be used with caution as the drug has not been studied in patients with liver disease.
- The manufacturer has not recommended any dosage adjustment in patients with liver disease.
Bleeding is the major and most common adverse effect like all other anticoagulants. Bleeding may occur at any site.
Side Effects of Desirudin (Iprivask):
- Cardiovascular:
- Deep vein thrombophlebitis
- Dermatologic:
- Wound secretion
- Gastrointestinal:
- Nausea
- Hematologic & oncologic:
- Hematoma
- Anemia
- Major hemorrhage may include
- Hemophthalmos
- Intracranial hemorrhage
- Intraspinal hemorrhage
- Prosthetic joint hemorrhage
- Retroperitoneal hemorrhage
- Local:
- Residual mass at the injection site
Contraindications to Desirudin (Iprivask):
- Allergy to natural or synthetic hirudins, or any component of this formulation
- Patients who are bleeding actively
- Patients with irreversible bleeding disorders
Warnings and precautions
- Anaphylaxis or hypersensitivity reactions
- It is possible to experience hypersensitivity and allergic reactions.
- Anaphylactoid reactions may lead to fatalities in some patients.
- Patients who have had an allergic reaction to the drug in the past should not be exposed again to it.
- Bleeding
- Any site may experience bleeding during treatment, including bleeding into the brain, gastrointestinal tract or vaginal.
- Patients at high risk for bleeding can be seriously and even fatal.
- The following patients are at high risk of bleeding:
- recent major surgery
- Patients who have had an organ biopsy or punctured a non-compressible vessel in the past month;
- Patients with intracranial bleeding or intraocular bleeding (including diabetic haemorrhagic retinalopathy)
- Patients who have had an ischemic stroke in the past;
- Patients who have suffered from gastrointestinal bleeding in the last three months or bleeding from their lungs;
- bacterial endocarditis;
- Patients with acquired or congenital bleeding disorders.
- Patients suffering from severe, uncontrolled hypertension
- Patients with a history hemorhagic stroke.
- Thrombocytopenia and platelet function deficiencies;
- Kidney disease
- Liver disease
- Patients undergoing invasive procedures.
- You should not take the drug with any other medication that could cause bleeding.
- Patients should be closely monitored, particularly those who are at high risk for bleeding.
- Hepatic impairment
- Patients with liver disease may have a higher risk of bleeding. Patients with hepatic impairment should use it with caution.
- Renal impairment
- Patients with severe or moderate renal impairment, especially those with moderate or severe, should be cautious when taking the drug.
- These patients may require dosage adjustment.
- Daily monitoring of the aPTT as well as renal function is recommended.
Desirudin (United States: Not available): Drug Interaction
Note: Drug Interaction Categories:
- Risk Factor C: Monitor When Using Combination
- Risk Factor D: Consider Treatment Modification
- Risk Factor X: Avoid Concomitant Use
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Risk Factor C (Monitor therapy). |
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Antiplatelet Agents (e.g. P2Y12 inhibitors NSAIDs, SSRIs etc.) |
May increase the anticoagulant effects of Anticoagulants. |
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Bromperidol |
May increase the toxic/adverse effects of Anticoagulants. |
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Caplacizumab |
May increase the anticoagulant effects of Anticoagulants. |
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Collagenase (Systemic) |
Anticoagulants can increase the toxic/adverse effects of Collagenase Systemic. In particular, there may be an increase in the risk of bleeding and/or bruising at the injection site. |
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May increase the anticoagulant effects of Anticoagulants. |
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Anticoagulants can increase the toxic/adverse effects of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. |
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Anticoagulants can increase the toxic/adverse effects of Deoxycholic Acid. The risk of bleeding or bruising may increase in the treatment area. |
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Fat Emulsion (Fish oil-based) |
May increase the anticoagulant effects of Anticoagulants. |
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Anticoagulants can increase the toxic/adverse effects of Ibritumomab Tiuxetan. Both agents could increase bleeding risk. |
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May increase the toxic/adverse effects of Anticoagulants. |
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May increase the anticoagulant effects of Anticoagulants. |
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Limaprost |
May increase the toxic/adverse effects of Anticoagulants. There may be an increase in bleeding risk. |
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Anticoagulants can increase the toxic/adverse effects of Nintedanib. Particularly, bleeding risks may be increased. |
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Nonsteroidal Anti-Inflammatory Drugs |
May increase the anticoagulant effects of Anticoagulants. |
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Anticoagulants can increase the toxic/adverse effects of Obinutuzumab. In particular, there may be an increase in the risk of bleeding-related complications. |
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Omega-3 Fatty Acids |
May increase the anticoagulant effects of Anticoagulants. |
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May decrease the therapeutic effects of Anticoagulants. Oritavancin can artificially increase laboratory results used to measure anticoagulant effectiveness. This could make it difficult to determine if anticoagulant doses should be decreased. |
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May increase the anticoagulant effects of Anticoagulants. |
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Prostacyclin Analogues |
May increase the toxic/adverse effects of Anticoagulants. Combining these anticoagulants may increase the risk of bleeding from the combination. |
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Salicylates |
May increase the anticoagulant effects of Anticoagulants. |
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May increase the anticoagulant effects of Anticoagulants. |
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Sulodexide |
May increase the anticoagulant effects of Anticoagulants. |
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May decrease the therapeutic effects of Anticoagulants. Telavancin can artificially increase laboratory results used to measure anticoagulant effectiveness. This could make it difficult to determine the correct dose. |
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Tibolone |
May increase the anticoagulant effects of Anticoagulants. |
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Tipranavir |
May increase the anticoagulant effects of Anticoagulants. |
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Vitamin E (Systemic) |
May increase the anticoagulant effects of Anticoagulants. |
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Risk Factor D (Regard therapy modification) |
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Anticoagulants |
Desirudin may increase the anticoagulant effects. |
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Corticosteroids (Systemic) |
Desirudin may have an increased anticoagulant activity. Corticosteroids can increase hemorhagic risk in desirudin therapy. Treatment: Stop taking systemic corticosteroids before desirudin treatment begins. Concomitant use should not be allowed. Patients receiving these combination medications should be closely monitored for signs and symptoms of excessive anticoagulation. |
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Estrogen Derivatives |
May decrease the anticoagulant effects of Anticoagulants. Particularly, some estrogens and progestin/estrogen combination may have prothrombotic side effects that could counteract anticoagulant properties. Management: Consider the potential benefits of estrogens in relation to the increased risk of thromboembolism and procoagulant effects. Some circumstances may make estrogens contraindicated. For more information, refer to the guidelines. Tibolone is an exception. |
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Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry |
Can increase the toxic/adverse effects of Anticoagulants. Possible bleeding. |
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Progestins |
Anticoagulants may have a reduced therapeutic effect. Progestin-estrogen combination and some progestins may have prothrombotic side effects that could counteract anticoagulant properties. Management: Consider the pros and cons of progestins in relation to the possible increased risk of thromboembolism or procoagulant effects. Some circumstances may make progestins contraindicated. For more information, refer to the guidelines. |
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Thrombolytic Agents |
Desirudin may increase its anticoagulant effects. Treatment: Stop using thrombolytic drugs prior to desirudin initiation. Concomitant use should not be allowed. Patients receiving these combination therapies should be closely monitored for signs and symptoms of excessive anticoagulation. |
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Risk Factor X (Avoid Combination) |
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May increase the anticoagulant effects of Anticoagulants. Refer to the separate drug interaction content as well as the full drug monograph content for apixaban and vitamin K antagonists (eg warfarin, Acenocoumarol) during anticoagulant transitions and bridging periods. |
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Dabigatran Etexilate |
May increase the anticoagulant effects of Anticoagulants. Refer to the separate drug interaction content as well as the full drug monograph content for dabigatran, etexilate, and vitamin K antagonists (eg warfarin, Acenocoumarol) during anticoagulant transitions and bridging periods. |
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Desirudin may have an increased anticoagulant effect. More specifically, dextran may increase hemorrhagic risk during desirudin treatment. When possible, stop taking dextran before desirudin treatment begins. Concomitant use should not be allowed. Patients receiving the combination should be closely monitored for signs and symptoms of excessive anticoagulation. |
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Edoxaban |
May increase the anticoagulant effects of Anticoagulants. Refer to the separate drug interaction and full drug monograph contents regarding edoxaban and vitamin K antagonists (eg warfarin, Acenocoumarol) during anticoagulant transition or bridging periods. Management: A limited amount of combined use may be recommended during transitions from one anticoagulant treatment to another. For specific information on switching anticoagulant treatment, see the full edoxaban drug monograph. |
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Hemin |
May increase the anticoagulant effects of Anticoagulants. |
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Anticoagulants may have an adverse/toxic effect that can be increased. In particular, bleeding risk may increase. |
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Omacetaxine's toxic/adverse effects may be exacerbated by anticoagulants. In particular, bleeding-related events can be more common. Patients with a lower platelet count than 50,000/uL should not use anticoagulants and omacetaxine simultaneously. |
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Rivaroxaban's anticoagulant effects may be enhanced by anticoagulants. Refer to the separate drug interaction content as well as the full drug monograph content for rivaroxaban use with vitamin K antagonists (eg warfarin, Acenocoumarol) during anticoagulant Transition and Bridging Periods. |
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Urokinase |
May increase the anticoagulant effects of Anticoagulants. |
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May increase the toxic/adverse effects of Anticoagulants. This combination may increase bleeding risk. |
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Monitoring parameters:
- Monitor for the clinical features of bleeding
- aPTT should be monitored daily in patients who are at risk of bleeding such as those with renal impairment.
- Patients with renal impairment should have serum creatinine monitored daily.
How to administer Desirudin (Iprivask)?
- It is administered as a deep subQ injection.
- Intramuscular injection should be avoided.
- It may be administered into the anterior abdominal wall or thighs.
- The injection site should be rotated.
- The skin fold should be held between the thumb and the forefinger and the whole needle should be inserted.
- The skin fold should be held throughout the injection.
- After the injection, the area of the injection should not be rubbed.
Mechanism of action of Desirudin (Iprivask):
- It is a selective inhibitor of thrombin and works by binding reversibly to the active sites of free and clot associated thrombin.
- It prolongs activated partial thromboplastin times (aPTT), but in a dose-dependent fashion.
- It prolongs the aPTT through inhibiting fibrin formation and thrombin-induced platelet aggregation and inhibiting coagulation factor V, VII and XIII.
Absorption:
- Absorption is complete when the drug is administered subcutaneously.
Metabolism:
- It is metabolized by carboxypeptidases.
Half-life elimination:
- About 2 hours;
- The half-life of the drug is prolonged in patients with renal impairment (CrCl <31 mL/minute/1.73 m²: Up to 12 hours)
Time to peak plasma concentration:
- 1 to 3 hours
Excretion:
- About half of the drug is excreted in urine unchanged.
International Brands of Desirudin (Iprivask):
- Iprivask
- Revasc
Desirudin Brand Names in Pakistan:
No Brands Available in Pakistan.
