dalteparin (Injection; Fragmin)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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SIDE EFFECTS: The most frequent adverse reactions are:

An immune reaction resulting in a drop in platelets and clotting (heparin-induced thrombocytopenia) is very rare, and significantly lower than with heparin use. LMWHs should be avoided in patients with epidural or spinal punctures as there is significant risk of spinal or epidural hematomas resulting in paralysis.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS:

  • Single-dosed prefilled syringe: 2500 units (u)/0.2 mL, 5000 u/0.2 mL, 7500 u/0.3 mL, 12,500 u/0.5 mL, 15,000 u/0.6 mL, 18,000 u/0.72 mL
  • Single-dose graduated syringe: 10,000 u/mL
  • Multiple dose vial: 95,000 u/9.5 mL, 95,000u/3.8 mL

STORAGE: Store at room temperature, between 20 C to 25 C (68 F to 77 F).

DOSING: To prevent blood clots in immobile patients at risk for clots or high risk patients undergoing abdominal surgery or hip replacement, the dose is 5000 units subcutaneously (SQ) once daily. In low risk abdominal surgery patients, the dose is 2500 units SQ once daily. To treat clots in cancer patients, the dose is 200 units per kg weight SQ once daily (max 18,000 units) for month 1, followed by 150 units per kg weight SQ once daily (max 18,000 units) during months 2 to 6. To treat clots in unstable angina or heart attack, the dose is 120 units per kg weight (max 10,000 units) every 12 hours.

DRUG INTERACTIONS: Combining dalteparin with other blood thinning agents may increase the risk of severe bleeding. Dalteparin should not be combined with urokinase or other anticoagulants such as apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto). Therapy should be monitored when used with platelet inhibitors (such as aspirin and clopidogrel [Plavix]), serotonin reuptake inhibitors (such as sertraline [Zoloft] and fluoxetine [prozac, Sarafem, Prozac Weekly]), and nonsteroidal anti-inflammatory drugs (such as ibuprofen). Dalteparin may increase potassium levels, so caution with and monitoring of potassium levels is advised with drugs such as ACE inhibitors (for example, lisinopril [Zestril, Prinivil]), angiotensin II receptor blockers (for example, losartan [Cozaar]), and other drugs like aliskiren, spironolactone (Aldactone), eplerenone, and potassium salts.

Medically Reviewed by a Doctor on 9/28/2015
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