Innohep

What is Innohep (tinzaparin)?

Tinzaparin is a blood thinner (anticoagulant) that prevents blood clots from forming in the body.

Tinzaparin is used together with warfarin (Coumadin) to treat a type of blood clot called deep vein thrombosis, or DVT. This condition sometimes occurs with a blood clot in lungs (pulmonary embolism).

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

What is the most important information I should know about Innohep (tinzaparin)?

You should not use this medication if you have low levels of blood platelets caused by using heparin, or if you are allergic to tinzaparin, heparin, sulfites, benzyl alcohol, or pork products.

Tinzaparin may cause severe or life-threatening side effects if you use it while you have any active bleeding or hemorrhage, or if you have: a bleeding disorder, hemorrhagic stroke, bacterial endocarditis, severe high blood pressure, stomach bleeding, liver failure, amyloidosis (a build-up of certain proteins in tissues and organs of the body), recent brain/spine or eye surgery, or if you are 70 years or older and have not recently had your kidney function checked.

Tell your doctor about all other medications you have recently used, especially drugs that can prevent blood from clotting, such as heparin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), ticlopidine (Ticlid), non-steroidal anti-inflammatory drugs (NSAIDs), and others.

What should I discuss with my healthcare provider before using Innohep (tinzaparin)?

You should not use this medication if you have low levels of blood platelets caused by using heparin, or if you are allergic to:

• tinzaparin;

• heparin;

• sulfites;

• benzyl alcohol; or

• pork products.

Tinzaparin may cause severe or life-threatening side effects if you use it while you have any active bleeding or hemorrhage, or if you have:

• a bleeding disorder that is inherited or caused by disease;

• a history of hemorrhagic stroke;

• bacterial endocarditis (infection of the heart's inner layer);

• untreated or uncontrolled high blood pressure;

• stomach bleeding or ulcer;

• liver failure;

• amyloidosis (a build-up of certain proteins in tissues and organs of the body);

• if you have had recent surgery on your brain, spine, or eyes; or

• if you are 70 years or older and have not recently had your kidney function checked.

Tinzaparin may cause bleeding around the brain or spinal cord if it is given while you are using certain other drugs that can prevent blood from clotting.. Before you receive tinzaparin, tell your doctor if you have recently used any of the following drugs:

• abciximab (ReoPro);

• ardeparin (Normiflo);

• argatroban (Acova);

• bivalirudin (Angiomax);

• cilostazol (Pletal);

• clopidogrel (Plavix);

• dipyridamole (Persantine);

• enoxaparin (Lovenox);

• eptifibatide (Integrelin);

• fondaparinux (Arixtra);

• heparin;

• lepirudin (Refludan);

• ticlopidine (Ticlid);

• tirofiban (Aggrastat); or

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), ketorolac (Toradol), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.

If you have certain conditions, you may need a dose adjustment or special tests to safely use tinzaparin. Before receiving tinzaparin, tell your doctor if you have:

• kidney disease;
• liver disease;

• high blood pressure;

• a blood-clotting disorder such as hemophilia; or

• blood vessel damage in the eyes (retinopathy) caused by diabetes.

How should I use Innohep (tinzaparin)?

Tinzaparin must not be used as a substitute for heparin. These two drugs are manufactured differently and have different dosages.

Tinzaparin is given as an injection under the skin of your stomach. Your doctor, nurse, or other healthcare provider will give you this injection. You may be shown how to inject your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

This medication is usually given every day until your bleeding condition improves. Follow your doctor's instructions.

Do not draw your tinzaparin dose into a syringe until you are ready to give yourself an injection. Do not use the medication if it has changed colors or has any particles in it. Call your doctor for a new prescription.

Use a different place on your stomach each time you inject this medication. Do not inject tinzaparin into the same skin area two times in a row.

To be sure this medication is helping your condition and is not causing harmful effects, your blood and your stool (bowel movement) will need to be tested on a regular basis. Your nerve and muscle function may also need to be tested. Do not miss any scheduled visits to your doctor.

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 can cause unusual bleeding from wounds or needle injections, nosebleeds, bloody or tarry stools, blood in the urine, and easy bruising or bleeding.

What should I avoid while using Innohep (tinzaparin)?

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Innohep (tinzaparin) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using tinzaparin and call your doctor at once if you have any of these serious side effects:

• unusual bleeding such as nosebleeds, bleeding gums, or any bleeding that will not stop;

• pale skin, weakness, easy bruising, purple or red pinpoint spots under your skin;

• unexpected vaginal bleeding;

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

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

• numbness or tingly feeling, trouble swallowing;

• loss of movement in any part of your body;

• chest pain, stomach pain, shortness of breath;

• fever;

• feeling like you might pass out; or

• penis erection that is painful or lasts 4 hours or longer;

Less serious side effects may include:

• mild headache, dizziness;

• back pain, mild joint or muscle pain;

• pain, irritation, swelling, or bruising of the skin where the medicine was injected;

• nausea, vomiting, upset stomach, gas;

• pain or burning when you urinate;

• diarrhea, constipation; or

• sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Innohep (tinzaparin)?

Tell your doctor about all other medications you are using, especially:

• dextran (Gentran, Hyskon);

• salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan's Pills Extra Strength, Tricosal, and others;

• other medication used to prevent blood clots, such as alteplase (Activase), or urokinase (Abbokinase).

This list is not complete and there may be other drugs that can interact with tinzaparin. 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 pharmacist can provide more information about tinzaparin.

• 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.