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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

dialysis [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

dialysis Avoid Use.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.
Lepirudin