Interactions : אינטראקציות

4.5   Interaction with other medicinal products and other forms of interaction
Antiplatelet drugs (aspirin, ticlopidine, clopidogrel, prasugrel, ticagrelor, dipyridamole in high doses), fibrinolytics, other anticoagulants (coumarin derivatives), oral factor Xa inhibitors (apixaban, rivaroxaban), thrombin inhibitors (bivalirudin, argatroban, dabigatran), hirudin (desirudin), non-steroidal anti-inflammatory drugs (phenylbutazone, indometacin), glycoprotein IIb/IIIa receptor antagonists, high-dose penicillin, dextrans: Clinically significant increased effect and increased risk of bleeding.

Cytostatics
Increase in the effect of heparin: doxorubicin probably attenuates the effect.

Nitroglycerin, administered intravenously
A clinically significant reduction in the effect of heparin can arise with the intravenous administration of nitroglycerin. After nitroglycerin is stopped, there may be a sharp rise in the aPTT. Close monitoring of the aPTT and adjustment of the heparin dose are necessary during the concomitant infusion of nitroglycerin.

Ascorbic acid, digitalis, tetracyclines, smoking
Inhibition of the effect of heparin.

Medicinal products bound to plasma proteins (e.g. propranolol)
Increase in the effect through displacement from plasma protein binding sites.
Medicinal products that increase the serum potassium level
Medicinal products that increase the serum potassium level must only be used concomitantly with Heparin Sodium if there is particularly careful medical monitoring.

Basic medicinal products (tricyclic antidepressants, antihistamines and quinine) Reciprocal reduction in the effect through salt formation with heparin.