Home Drug Guide Desirudin

Drug Guide

Generic Name

Desirudin

Brand Names Iprivask

Classification

Therapeutic: Anticoagulant

Pharmacological: Direct Thrombin Inhibitor

FDA Approved Indications

  • Prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip replacement surgery

Mechanism of Action

Desirudin is a recombinant analog of hirudin that directly inhibits thrombin, preventing fibrin formation and clot development.

Dosage and Administration

Adult: It is typically administered as a subcutaneous injection once daily. The dosage depends on the patient's weight and clinical condition. For prophylaxis, a common dose is 15 mg subcutaneously 6 hours after surgery, then 15 mg every 12 hours.

Pediatric: Not approved for use in pediatric patients; safety and efficacy not established.

Geriatric: Dose adjustments may be necessary based on renal function; careful monitoring is advised.

Renal Impairment: Dose adjustment is required in patients with renal impairment; specific guidelines recommend reducing dose or extending dosing interval based on creatinine clearance.

Hepatic Impairment: No specific adjustments recommended; caution advised. Liver function should be monitored.

Pharmacokinetics

Absorption: Rapid absorption following subcutaneous administration.

Distribution: Widely distributed; volume of distribution approximately 0.1-0.2 L/kg.

Metabolism: Metabolized primarily by proteolytic cleavage, with no significant hepatic metabolism.

Excretion: Excreted mainly by the kidneys.

Half Life: Approximately 4-6 hours.

Contraindications

  • Active major bleeding
  • Known hypersensitivity to desirudin or hirudin derivatives

Precautions

  • Use with caution in patients with bleeding disorders, recent surgery, or trauma. Monitor renal function regularly.

Adverse Reactions - Common

  • Bleeding at injection site (Common)
  • Nausea (Less common)

Adverse Reactions - Serious

  • Serious bleeding, including intracranial or retroperitoneal hemorrhage (Rare)
  • Anaphylaxis (Very rare)

Drug-Drug Interactions

  • Other anticoagulants, antiplatelet agents, NSAIDs, thrombolytics may increase bleeding risk.

Drug-Food Interactions

  • No significant interactions reported.

Drug-Herb Interactions

  • Patients should avoid herbal supplements that may increase bleeding risk, such as ginseng, garlic, or ginkgo.

Nursing Implications

Assessment: Monitor for signs of bleeding, including sudden drops in hemoglobin, hematocrit, blood pressure drops, and bleeding at puncture sites.

Diagnoses:

  • Risk for bleeding related to anticoagulant therapy.

Implementation: Administer subcutaneously as prescribed; ensure proper injection techniques.

Evaluation: Assess for bleeding complications regularly. Adjust dose based on renal function and clinical response.

Patient/Family Teaching

  • Instruct patient to report any signs of bleeding, unusual bruising, blood in urine or stool.
  • Advise on the importance of adherence to dosing schedule.
  • Warn about avoid use of NSAIDs or aspirin unless directed by healthcare provider.

Special Considerations

Black Box Warnings:

  • Risk of hemorrhage.

Genetic Factors: No specific genetic considerations known.

Lab Test Interference: May interfere with coagulation assays; INR is not used to monitor effect.

Overdose Management

Signs/Symptoms: Excessive bleeding, hematoma formation.

Treatment: Discontinue drug immediately. Supportive measures include applying pressure to bleeding sites, transfusions if necessary. No specific antidote available; recovery depends on renal clearance.

Storage and Handling

Storage: Store in a refrigerator at 2°C to 8°C. Protect from freezing and light.

Stability: Stable until expiration date if stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.