lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Oral suspension
▶Dipyridamole (Non-proprietary)
Dipyridamole 10 mg per 1 mlDipyridamole 50 mg/ 5 ml oral
suspension sugar free sugar-free| 150 mlP£ 39. 40 DT = £ 39. 40
Dipyridamole 40 mg per 1 mlDipyridamole 200 mg/ 5 ml oral
suspension sugar free sugar-free| 150 mlP£ 133. 53 DT =
£ 133. 53
Tablet
CAUTIONARY AND ADVISORY LABELS 22
▶Dipyridamole (Non-proprietary)
Dipyridamole 25 mgDipyridamole 25 mg tablets| 84 tabletP
£ 9. 40 DT = £ 9. 40
Dipyridamole 100 mgDipyridamole 100 mg tablets|
84 tabletP£ 12. 50 DT = £ 3. 88
▶Persantin(Boehringer Ingelheim Ltd)
Dipyridamole 100 mgPersantin 100 mg tablets| 84 tabletP
£ 6. 30 DT = £ 3. 88
ANTITHROMBOTIC DRUGS›HEPARINOIDS
Danaparoid sodium
lINDICATIONS AND DOSE
Thromboembolic disease in patients with history of
heparin-induced thrombocytopenia
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 30 units/kg, then (by continuous
intravenous infusion) 1. 2 – 2 units/kg/hour, infusion
dose to be adjusted according to coagulation activity.▶Child 1 month–15 years (body-weight up to 55 kg):Initially
30 units/kg (max. per dose 1250 units), then (by
continuous intravenous infusion) 1. 2 – 2 units/kg/hour,
infusion dose to be adjusted according to coagulation
activity
▶Child 1 month–15 years (body-weight 55 kg and above):
Initially 30 units/kg (max. per dose 2500 units), then
(by continuous intravenous infusion)
1. 2 – 2 units/kg/hour, infusion dose to be adjusted
according to coagulation activity
▶Child 16–17 years (body-weight up to 55 kg):Initially
1250 units, then (by continuous intravenous infusion)
400 units/hour for 2 hours, then (by continuous
intravenous infusion) 300 units/hour for 2 hours, then
(by continuous intravenous infusion) 200 units/hour
for 5 days, infusion dose to be adjusted according to
coagulation activity
▶Child 16–17 years (body-weight 55–90 kg):Initially
2500 units, then (by continuous intravenous infusion)
400 units/hour for 2 hours, then (by continuous
intravenous infusion) 300 units/hour for 2 hours, then
(by continuous intravenous infusion) 200 units/hour
for 5 days, infusion dose to be adjusted according to
coagulation activity
▶Child 16–17 years (body-weight 91 kg and above):Initially
3750 units, then (by continuous intravenous infusion)
400 units/hour for 2 hours, then (by continuous
intravenous infusion) 300 units/hour for 2 hours, then
(by continuous intravenous infusion) 200 units/hour
for 5 days, infusion dose to be adjusted according to
coagulation activitylUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSActive peptic ulcer (unless this is
the reason for operation).acute bacterial endocarditis.
diabetic retinopathy.epidural anaesthesia (with treatment
doses).haemophilia and other haemorrhagic disorders.
recent cerebral haemorrhage.severe hypertension.spinal
anaesthesia (with treatment doses).thrombocytopenia
(unless patient has heparin-induced thrombocytopenia)
lCAUTIONSAntibodies to heparins (risk of antibody-
induced thrombocytopenia).body-weight over 90 kg.
recent bleeding.risk of bleeding
lINTERACTIONS→Appendix 1 : danaparoid
lSIDE-EFFECTS
▶Common or very commonHaemorrhage.heparin-induced
thrombocytopenia.skin reactions.thrombocytopenia
lPREGNANCYManufacturer advises avoid—limited
information available but not known to be harmful.
lBREAST FEEDINGAmount probably too small to be
harmful but manufacturer advises avoid.
lHEPATIC IMPAIRMENTCaution in moderate impairment
(increased risk of bleeding). Avoid in severe impairment
unless patient has heparin-induced thrombocytopenia and
no alternative available.
lRENAL IMPAIRMENTUse with caution in moderate
impairment. Avoid in severe impairment unless patient
has heparin-induced thrombocytopenia and no alternative
available.
MonitoringIncreased risk of bleeding in renal impairment,
monitor anti-Factor Xa activity.
lMONITORING REQUIREMENTSMonitor anti factor Xa
activity in patients with body-weight over 90 kg.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, dilute with Glucose 5 % or Sodium Chloride 0. 9 %.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Danaparoid sodium (Non-proprietary)
Danaparoid sodium 1250 unit per 1 mlDanaparoid sodium
750 units/ 0. 6 ml solution for injection ampoules| 10 ampouleP
£ 599. 99ANTITHROMBOTIC DRUGS›HEPARINS
Heparins f
lCONTRA-INDICATIONSAcute bacterial endocarditis.after
major trauma.epidural anaesthesia with treatment doses.
haemophilia and other haemorrhagic disorders.peptic
ulcer.recent cerebral haemorrhage.recent surgery to eye.
recent surgery to nervous system.severe hypertension.
spinal anaesthesia with treatment doses.
thrombocytopenia (including history of heparin-induced
thrombocytopenia)
lSIDE-EFFECTS
▶Common or very commonHaemorrhage.heparin-induced
thrombocytopenia.skin reactions.thrombocytopenia.
thrombocytosis
▶UncommonCNS haemorrhage
▶Rare or very rareAlopecia.hyperkalaemia.osteoporosis.
priapism
▶Frequency not knownHypoaldosteronism
SIDE-EFFECTS, FURTHER INFORMATION
HaemorrhageIf haemorrhage occurs it is usually
sufficient to withdraw unfractionated or low molecular
weight heparin, but if rapid reversal of the effects of the
heparin is required, protamine sulfate is a specific antidote
(but only partially reverses the effects of low molecular
weight heparins).
Heparin-induced thrombocytopeniaClinically
important heparin-induced thrombocytopenia is immune-
mediated and can be complicated by thrombosis. Signs of
heparin-induced thrombocytopenia include a 30 %
reduction of platelet count, thrombosis, or skin allergy. If
heparin-induced thrombocytopenia is strongly suspected
or confirmed, the heparin should be stopped and anBNFC 2018 – 2019 Thromboembolism 93
Cardiovascular system2