Dalteparin

What is dalteparin?

Dalteparin is an anticoagulant (blood thinner) that prevents the formation of blood clots.

Dalteparin is used to treat or prevent blood clots in the veins, arteries, or lung that can be caused by cancer or certain heart conditions. Dalteparin is also used before surgery to reduce the risk of blood clots.

Dalteparin may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about dalteparin?

You should not receive this medication if you are allergic to dalteparin or pork products, or if you have uncontrolled bleeding, a severe lack of platelets in your blood, or if you are having surgery with spinal or epidural anesthesia.

Before you receive dalteparin, tell your doctor if you have eye problems caused by diabetes or high blood pressure, an infection of your heart, uncontrolled high blood pressure, a bleeding or blood clotting disorder, stomach or intestinal bleeding, liver disease, or if you have ever had a blood cell problem caused by heparin.

What should I discuss with my healthcare provider before receiving dalteparin?

You should not receive this medication if you are allergic to dalteparin, or if you have:

• uncontrolled bleeding;

• a severe lack of platelets in your blood;

• if you are having surgery with spinal or epidural anesthesia; or

• if you are allergic to pork products.

Before using dalteparin, tell your doctor if you are allergic to any drugs, or if you have:

• eye problems caused by diabetes or high blood pressure,

• an infection of the lining of your heart (also called bacterial endocarditis);

• uncontrolled high blood pressure;

• a bleeding or blood clotting disorder, such as hemophilia;

• stomach or intestinal bleeding or disorder;

• kidney disease;

• liver disease; or

• if you have ever had a blood cell problem after receiving heparin.

If you have any of these conditions, you may need a dose adjustment or special tests to safely use dalteparin.

How should I use dalteparin?

Dalteparin is given as an injection under the skin of your stomach, upper thigh, or buttocks. Your doctor, nurse, or other healthcare provider will give you this injection. You may be given instructions on how to inject your medicine at home. Do not use this medicine at home if you do not fully understand how to give the injection and properly dispose of needles and syringes used in giving the medicine.

You should be sitting or lying down while receiving a dalteparin injection.

Use a different place on your body each time you give yourself an injection. Your doctor will show you the places on your body where you can safely inject dalteparin. Do not inject this medicine into the same place two times in a row.

If you are using a single-dose prefilled syringe, follow the injection instructions closely. Single-dose syringes come in two different types and the directions for use are not the same for each type.

Use each disposable needle only one time. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your kidney function may also need to be tested. Do not miss any scheduled appointments..

Do not use any medication that is discolored or that has particles in it. Call your doctor for a new prescription.

What happens if I miss a dose?

Use the medication as soon as you remember the missed dose. If it is almost time for your next dose, skip the missed dose and use the medicine at your next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include bruising, nosebleed, blood in your urine or stools, or any bleeding that will not stop.

What should I avoid while using dalteparin?

Avoid taking aspirin while you are receiving dalteparin unless your doctor recommends it as part of your treatment. Aspirin can increase your risk of bleeding.

Dalteparin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; itching or burning skin; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• easy bruising or bleeding, unusual weakness;

• any bleeding that will not stop;

• blood in your urine or stools, black or tarry stools;

• coughing up blood or vomit that looks like coffee grounds;

• bruising, bleeding, swelling, or skin changes where the medicine was injected;

• nausea, sweating, feeling light-headed, fainting;

• sudden numbness or weakness, especially on one side of the body;

• sudden headache, confusion, problems with vision, speech, or balance;

• pain or swelling in one or both legs; or

• trouble breathing.

Less serious side effects include mild pain, redness, or warmth where the medicine was injected.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Dalteparin Dosing Information

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Abdominal Surgery:

2500 intl units subcutaneously once a day, beginning 1 to 2 hours prior to surgery and continuing for 5 to 10 days postoperatively.

Usual Adult Dose for Venous Thromboembolism:

First 30 days of therapy: approximately 200 intl units/kg ABW, not to exceed 18,000 intl units subcutaneously once daily for the first 30 days of therapy. The following doses should be given based on patient weight:
56 kg or less: 10,000 intl units subcutaneously once daily
57 to 68 kg: 12,500 intl units subcutaneously once daily
69 to 82 kg: 15,000 intl units subcutaneously once daily
83 to 98 kg: 18,000 intl units subcutaneously once daily
99 kg or more: 18,000 intl units subcutaneously once daily

For months 2 to 6: approximately 150 intl units/kg ABW, not to exceed 18,000 intl units subcutaneously once daily should be given. The following doses should be given based on patient weight:
56 kg or less: 7500 intl units subcutaneously once daily
57 to 68 kg: 10,000 intl units subcutaneously once daily
69 to 82 kg: 12,500 intl units subcutaneously once daily
83 to 98 kg: 15,000 intl units subcutaneously once daily
99 kg or more: 18,000 intl units subcutaneously once daily

The daily dose of dalteparin should be reduced by 2,500 intl units in patients with platelet counts between 50,000 and 100,000/mm3 until the platelet count recovers to greater than or equal to 100,000/mm3. In patients who experience platelet counts less than 50,000/mm3, dalteparin should be discontinued until the platelet count recovers above 50,000/mm3.

Safety and efficacy beyond six months has not been evaluated in patients with cancer and acute symptomatic venous thromboembolism.

Usual Adult Dose for Myocardial Infarction:

120 intl units/kg (not to exceed 10,000 intl units) subcutaneously every 12 hours with concurrent aspirin therapy for 5 to 8 days.

Usual Adult Dose for Angina Pectoris:

120 intl units/kg (not to exceed 10,000 intl units) subcutaneously every 12 hours with concurrent aspirin therapy for 5 to 8 days.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Orthopedic Surgery:

2500 intl units twice a day or 5000 intl units once a day.

Usual Adult Dose for Deep Vein Thrombosis -- Prophylaxis:

5000 intl units subcutaneously once a day. The usual duration of administration in clinical trials was 12 to 14 days.

What other drugs will affect dalteparin?

There are many other drugs that can increase your risk of bleeding, and it is very important to tell your doctor if you are using any of them before you start using dalteparin. This includes:

• a blood thinner such as warfarin (Coumadin);

• other medications used to prevent blood clots, such as alteplase (Activase), anistreplase (Eminase), clopidogrel (Plavix), dipyridamole (Persantine), streptokinase (Kabikinase, Streptase), ticlopidine (Ticlid), and urokinase (Abbokinase);

• salicylates such as Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others; or

• NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), or piroxicam (Feldene).

There may be other drugs that can interact with dalteparin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your doctor or pharmacist can provide more information about dalteparin.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.