Drug information of Desirudin

Desirudin

Drug group:

Desirudin is a direct inhibitor of human thrombin. It has a protein structure that is similar to that of hirudin, the naturally occurring anticoagulant present in the peripharyngeal glands in the medicinal leech, Hirudomedicinalis.

Mechanism of effect

Desirudin is a direct, highly selective thrombin inhibitor. Reversibly binds to the active thrombin site of free and clot-associated thrombin. Inhibits fibrin formation, activation of coagulation factors V, VII, and XIII, and thrombin-induced platelet aggregation resulting in a dose-dependent prolongation of the activated partial thromboplastin time (aPTT).

Pharmacodynamic

Desirudin results in dose-dependent prolongation of the activated partial thromboplastin time (aPTT).

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%)  

Dosage

Adult

Deep Vein Thrombosis Prevention

15 mg SC q12hr; initiate 5-15 min before surgery (but after induction of regional block anesthesia) and continue for 9-12 days

Pediatric

Safety and efficacy not established

Alerts

  • 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])

Points of recommendation

Follow all directions on your prescription label. Do not use desirudin in larger or smaller amounts or for longer than recommended.

Use a different place on your stomach or thigh each time you give the injection.

While using desirudin, you may need frequent blood tests.

Store the powder and diluent at cool room temperature away from moisture, heat, and light. After mixing desirudin, store it at room temperature and use within 24 hours.

Avoid rubbing your skin after injecting desirudin, to prevent bruising.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Pregnancy level

C


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