Drug interactions summary

- Thrombolytics (eg. alteplase, streptokinase) Glucocorticocoids Dextran with  Desirudin

 increase risk of bleeding. Discontinue initiations of desirudin therapy  Anticoagulants (eg. heparin unfractionated) and LMWH with  Desirudin incr oncomittant treatment is not recommende.

- Antiplatelet and glycoprotein IIb/IIIa antagonists (eg. salicylates, NSAIDs, ketorolac, acetyl salicylic acid, ticlopodine, dypyridamole, clopidogrel, abciximab ) with - Desirudin

 use with caution in conjuntion with desirudin

Thrombolytics (eg. alteplase, streptokinase) Glucocorticocoids Dextran with  Desirudin 

Conomittant treatment with thrombolytics may increase risk of bleeding. Discontinue initiations of desirudin therapy

Anticoagulants (eg. heparin unfractionated) and LMWH with Desirudin incr during prophylaxis of venous thromboembolism concomittant treatment is not recommended. The effect iinclude prolongation of aPTT. As with other anticoagulants desirudin should be used with caution

Antiplatelet and glycoprotein IIb/IIIa antagonists (eg. salicylates, NSAIDs, ketorolac, acetyl salicylic acid, ticlopodine, dypyridamole, clopidogrel, abciximab ) with  Desirudin

 use with caution in conjuntion with desirudin

Deep vein thrombosis

Bleeding complications Thrombosis, hypotension, leg edema, fever, decreased hemoglobin, hematuria, dizziness, epistaxis, vomiting, impaired healing, cerbrovasscular disorder,leg pain, hematemesis

Hypersensitivity

Special precautions

Hemorrhagics events - zdesirudin not intended for IM injection, as local hematoma may result To be used with caution in patients with increased risk of hemorrhage such as recent major surgery, organ biopsy or puncture of noncompressible vessel within the last month, histort of hemorrhage, stroke, intracranial or onitraocular bleeding including diabetic hemorrhage, recent ischemic stroke

Spinal/epidural anesthesia- there is a risk of neuraxial hematoma formation with concurrent use of desirudin and spinal epidural anesthesia, which has the potential to result in long term permanent paralysis To reduce risks of potential bleeding associated with concurrent use, the pharmacokinetic profile of the drug should be considered when scheduling or using epidural or spinal anethesia

Interchangeability- Desirudin cannot be used interchangebly with other hirudins as differ in manufacturing process Hypersentivity reactions- antibodies have been reported in patients treated hirudins. potential for cross-sensitivity to hirudins products cannot be excluded.

Renal function impairment- must be used with caution in patients with renal impairment, paricularly in those with moderate and severe renal impairment creratinine clearance less than or equal to 60mL/min/1.73m2 body surface area)

Hepatic function impairment- no information available about use of desirudin in patients with hepatic insufficiency/liver injury. Desirudin should be used with caution in such patients

Pregnancy- to be used during pregnancy only if required Lactation- caution to be excercised when desirudin is administred to nursing women.

Children- safety and eficacy in pediatric patients not been established.

Elderly- can be used safely in geriatric population of patients younger than 65 years of age, so long renal function is adequate..

Indcation-

Deep vein thrombosis Hip replacement surgery- 15mg every 12hours administered SC injecvtion, with initial dose given up to 5 minutes prior to surgety , but after induction of regionallock anesthesia, if used.

Doage-

Up to 12days administration ( average duration 9m to 12 days ) of desirudin has been well tolerated in controlled clinical trials

Pharmacology

 Desirudin is a selective inhibitor of free circulating and clot-bound thrombin. The anticoagulant properties ofdesirudin are demonstrated by its ability to prolong the clotting time of human plasma

Pharmacokinetics

Absorption of desirudin is complete when administered SC doses of 0.3mg/kg or 0.5mg/kg After SC admin. the mean terminal half life is approx. 2 hours

Pregnancy

It is to be used during pregnancy only if required

Lactation

caution to be excercised when desirudin is administred to nursing women.

Children- safety and eficacy in pediatric patients not been established.

Elderly

can be used safely in geriatric population of patients younger than 65 years of age, so long renal function is adequate..