Heparin is an anticoagulating medication: it works by decreasing the ability of the blood to clot normally. While this may seem like an unwanted effect, in certain circumstances, decreasing the ability of blood to coagulate is exactly what is needed. Specifically, heparin is approved by the Federal Drug Administration to both prevent and treat conditions in which blood clots form abnormally; for instance, deep venous thrombosis, which is a clot in the leg or arm, may be treated with intravenous heparin. However, it is extremely important to be aware that certain medications may interact negatively with heparin.
Corticorelin and Heparin: "Avoid Combination"
Corticorelin is a drug that is considered to be part of a general class called "diagnostic agents"; specifically, it is used to determine if a diagnosis of a disease called Cushing's syndrome can be made. According to the medical reference UpToDate, this is the only medication that should be completely avoided when a patient is on heparin and is given the label "Risk X: Avoid combination." The interaction between these two drugs may result in dangerous drops in heart rate and blood pressure.
Drotrecogin Alfa and Heparin: "Consider Therapy Modification"
Drotrecogin alfa is a medication that is used to treat a serious, life-threatening condition called sepsis syndrome. The online pharmacology reference MicroMedex, citing multiple studies, reports that it may reduce the risk of death from severe sepsis, which is the term used to describe the presence of bacteria, or bacterial toxins, in the bloodstream. While it is not entirely clear how drotrecogin alfa decreases mortality from sepsis syndrome, one of the effects this medication has is to decrease the ability of the blood to clot. Since drotrecogin alfa enhances the anti-clotting effects of heparin, the benefits of putting the patient on one of these medications while already on the other should be weighed against the increased risk of bleeding. However, unlike the case with corticorelin, it is not recommended that drotrecogin alfa be completely avoided--only that possible alternatives be considered. Specifically, when rated in terms of risk, the drotrecogin alfa/heparin combination is considered to be "Risk D: Consider therapy modification"--an indication that there is less risk involved with this combination than with the corticorelin/heparin combination.
Other Medications and Heparin: "Monitor Therapy"
A wide range of other medications are considered "intermediate" in risk and are given the risk category "Risk C: Monitor Therapy." While the interaction between heparin and "Risk C" medications is considered to be less severe than, for instance, the interaction between heparin and corticorelin, there are still risks involved. For instance, according to the UpToDate drug interaction program "Lexi-Interact", patients taking aspirin while also taking heparin have a 2.5 times higher risk of bleeding compared to patients who receive heparin without aspirin. Nonsteroidal anti-inflammatory agents, also known as NSAIDs, are another group of medications whose interaction with heparin is considered to need monitoring. A commonly-used NSAID is ibuprofen; when taken at the same time as heparin, patients taking a medication such as ibuprofen are at increased risk for bleeding.
References
- MicroMedex: Heparin
- MicroMedex: Corticorelin
- "UpToDate"; Denise S. Basow; 2010
