Generic Name

Desirudin

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Classification

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

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.