Lepirudin  Refludan ®

Usual Diluents

D5W,   NS

Standard Dilutions   [Amount of drug]  [Infusion volume]  [Infusion rate]

[100 mg] [250 ml] [As directed] (Concentration: 0.4 mg/ml) [100 mg] [500 ml] [Titrate] (Concentration: 0.2 mg/ml)    [As directed]

Stability / Miscellaneous

EXP: 1 DAY (RT).  Recombinant hirudin derived from yeast cells. Used for treatment of disseminated intravascular coagulation, in particular heparin-induced thrombocytopenia type II.  Mechanism of action: reacts with thrombin in a 1:1 molar ratio to form a noncovalent complex; directly inhibits all actions of thrombin. There is no physiologic inhibitor of lepirudin.  Lepirudin provides more stable level of anticoagulation than heparin. Lepirudin does not require endogenous cofactors and acts independently of antithrombin-III.  Preparation: Bolus dose: use concentration of 5 mg/ml. Dilute 50mg vial with 1 ml NS or sterile water, then transfer to at least 10 ml syringe and qs to 10ml with sterile water, NS or D5W.  Continuous infusion: Dilute two 50mg vials, each with 1 ml sterile water or NS and add to 250 or 500ml bag of D5W or NS. (Concentration: 0.2 or 0.4 mg/ml)