Allopathy
Prescription Required
DCGI (Drugs Controller General of India)
Schedule H
Parnaparin is an anticoagulant agent belonging to low molecular weight Heparin.
Parnaparin is a low molecular weight heparin (LMWH) used to prevent blood clots, specifically deep vein thrombosis.
Parnaparin is distributed mainly in blood. Parnaparin has renal and hepatic metabolism. The peak plasma levels of anti-Xa activity are about 3 hours. The plasma half-life is approximately 6 hours. The anti-Xa activity persists in plasma for 20 hours after a single dose. Parnaparin is excreted in the urine.
Parnaparin shows common side effects like severe bleeding, allergic reactions like rash, and an increase in blood potassium.
Parnaparin is available in the form of an Injectable Solution.
Parnaparin is available in India, Europe, China, Japan, Italy, and Argentina.
Parnaparin belonging to the low molecular weight Heparin acts as an anticoagulant agent.
Parnaparin enhances the action of antithrombin III but, unlike heparin, it is characterised by a higher ratio of anti-factor Xa to anti-factor IIa (antithrombin) activity. It also has less effect on platelet aggregation than heparin; has no significant effect on blood coagulation tests such as aPTT.
The effect of Parnaparin is observed within 30-60 minutes of administration.
The effect of Parnaparin lasts for an average duration of 6-8 hours.
Parnaparin is available in the form of an Injectable solution.
Parnaparin Injection is given via a subcutaneous route.
Parnaparin is an anticoagulant used to prevent the formation and growth of blood clots in patients with certain specific medical conditions. It is also used to prevent blood clots that may potentially form during certain medical procedures.
Parnaparin is an anticoagulant agent belonging to low molecular weight Heparin.
Parnaparin enhances the action of antithrombin III but, unlike heparin, it is characterized by a higher ratio of anti-factor Xa to anti-factor IIa (antithrombin) activity. It also has less effect on platelet aggregation than heparin and has no significant effect on blood coagulation tests such as aPTT.
Parnaparin is approved for use in the following clinical indications
- Prophylaxis of postoperative venous thromboembolism
Used in the prevention and treatment of venous thromboembolism (deep vein thrombosis and pulmonary embolism) and in the treatment of myocardial infarction.
- Thromboembolic disorders
- Prophylaxis of postoperative venous thromboembolism
Adult Subcutaneous Dose:
For general surgical procedures: As sodium: Injection of 3200 units 2 hours before the procedure, followed by 3200 units once daily for 7 days or until the patient is fully ambulant.
For higher-risk surgery or orthopedic patients: As sodium: Injection of 4250 units 12 hours before the procedure, followed by 4250 units 12 hr post-op and then once daily for 10 days.
- Thromboembolic disorders
Adult Subcutaneous Dose: As sodium: Injection of 6400 units for 7-10 days.
Parnaparin is available in various strengths as 12800 IU/mL; 3200 IU/0.3mL; 4250 IU/0.4mL; 6400 IU/0.6mL; 8500 IU/0.8 mL.
Parnaparin is available in the form of an Injectable solution.
Avoid herbs and supplements with anticoagulant/antiplatelet activity. Examples include garlic, ginger, bilberry, danshen, piracetam, and ginkgo Biloba.
Parnaparin is contraindicated in patients with
- Do not give by Intramuscularly.
- History of thrombocytopenia with heparin
- Positive in-vitro platelet aggregation test (cross-reactivity) with parnaparin
- Conditions or diseases with increased risk of hemorrhage.
- Hemorrhage and risk factors
Use of Parnaparin should be initiated only after internal bleeding or hemorrhage and associated risk factors are ruled out. All the underlying causes of bleeding, such as peptic ulcer disease, hemophilia, impaired hemostasis, etc., should also be ruled out before the administration of Parnaparin.
- Thrombocytopenia
The use of Parnaparin may cause low levels of platelets (thrombocytopenia). It is advised to monitor the blood platelet levels at regular intervals while Parnaparin is administered. Appropriate dose adjustments or replacement with a suitable alternative may be necessary based on the clinical condition of the patient.
- Epidural/spinal/regional anesthesia
Parnaparin should not be used in patients receiving regional, epidural, or spinal anesthesia due to the increased risk of excessive bleeding and the formation of a hematoma.
- Interchangeability with other heparins
Parnaparin should not be used interchangeably with other low molecular-weight heparins.
- Benzyl alcohol as a preservative
Dosage forms containing benzyl alcohol as a preservative should not be administered to neonates, infants, or pregnant or breastfeeding women. Benzyl alcohol may cause a fatal adverse event known as the Gasping syndrome in neonates and infants.
Breast Feeding Warning
Parnaparin is recommended for use in breastfeeding women only when necessary and the potential benefits outweigh the risks involved.
Pregnancy Warning
Parnaparin is recommended for use in pregnant women only when necessary and the potential benefits outweigh the risks involved.
Food Warning
Avoid herbs and supplements with anticoagulant/antiplatelet activity. Examples include garlic, ginger, bilberry, danshen, piracetam, and ginkgo Biloba.
- Hyperkalaemia related to hypoaldosteronism, bleeding, thrombocytopenia, urticarial rash or hypersensitivity skin reactions, skin necrosis reactions (localized to or distant from the injection site), increase in transaminases.
- ACE inhibitors
Hyperkalaemia is observed in patients on ACE inhibitors.
- Oral anticoagulants or drugs
Increased risk of hemorrhage with oral anticoagulants or drugs (e.g. aspirin and dipyridamole) that affect platelet function.
The common side effects of Parnaparin include the following
● Severe bleeding, allergic reactions like rash, and an increase in blood potassium.
- Symptoms: Haemorrhage, nosebleed, unusual bruising and bleeding, and the presence of blood in stool or urine.
- Management: treatment of severe bleeding may be reduced by slow IV admin of protamine sulfate.
Pharmacodynamic
Information is not available.
Pharmacokinetics
Absorption
Information is not available.
- Distribution
Parnaparin is distributed mainly in blood.
- Metabolism and Excretion
Parnaparin is having renal and hepatic metabolism. The peak plasma levels of anti-Xa activity are about 3 hours. The plasma half-life is approximately 6 hours. The anti-Xa activity persists in plasma for 20 hours after a single dose. Parnaparin is excreted in the urine.
- Camporese G, Bernardi E, Noventa F. Update on the clinical use of the low-molecular-weight heparin, parnaparin. Vascular health and risk management. 2009;5:819.
- Lodigiani C, Dentali F, Banfi E, Ferrazzi P, Librè L, Quaglia I, Cafaro L, Morenghi E, Pacetti V, Zannoni E, Baggiani AM. The effect of parnaparin sodium on in vitro fertilization outcome: A prospective randomized controlled trial. Thrombosis Research. 2017 Nov 1;159:116-21.
- Imberti D, Baldini E, Pierfranceschi MG, Nicolini A, Cartelli C, De Paoli M, Boni M, Filippucci E, Cariani S, Bottani G. Prophylaxis of venous thromboembolism with low molecular weight heparin in bariatric surgery: a prospective, randomized pilot study evaluating two doses of parnaparin (BAFLUX Study). Obesity surgery. 2014 Feb;24(2):284-91.
- https://go.drugbank.com/drugs/DB09260
- https://www.mims.com/indonesia/drug/info/parnaparin?mtype=generic
- https://www.medindia.net/doctors/drug_information/parnaparin.htm#Sideeffects
- https://www.practo.com/medicine-info/parnaparin-792-api
