Lepirudin

Usual Dosing (Adults)

Heparin-induced thrombocytopenia: Bolus dose: 0.4 mg/kg IVP (over 15-20 seconds), followed by continuous infusion at 0.15 mg/kg/hour ( bolus and infusion must be reduced in renal insufficiency). Do not exceed 0.21 mg/kg/hour. Max initial bolus: 44 mg. Max initial infusion rate: 16.5 mg/hour.

Renal Dosing

[CRCL > 60 ml/min]: No changes.

[45-60 ml/min] or [Scr 1.6-2.0 mg/dL]:
Bolus dose: 0.2 mg/kg IVP (over 15-20 seconds).
Adjust rate to 50% of standard infusion rate: 0.075mg/kg/hour.

[30-44 ml/min] or [ Scr 2.1-3.0 mg/dL]:
Bolus dose: 0.2 mg/kg IVP (over 15-20 seconds).
Adjust rate to 30% of standard infusion rate: 0.045mg/kg/hour.

[15-29 ml/min] or [ Scr 3.1-6.0 mg/dL]:
Bolus dose: 0.2 mg/kg IVP (over 15-20 seconds)
Adjust rate to 15% of standard infusion rate: 0.0225mg/kg/hour.

[<15 ml/min] or [Scr>6.0 mg/dl]:
Avoid or STOP infusion.

Hemodialysis

Avoid Use.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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