What is dalteparin injection, and how does it work (mechanism of action)?
Dalteparin is a low molecular weight heparin (LMWH)
similar to enoxaparin
(Lovenox) and tinzaparin. Dalteparin is used to treat or prevent
blood clots and their complications (deep vein thrombosis or DVT and pulmonary
embolism or PE). Deep vein thrombosis is the formation of blood clots in veins
deep in a muscle, most often in the legs. Deep vein thrombosis may lead to
pulmonary embolism, a condition in which a piece of the clot (the embolus)
breaks loose and travels through the veins to the lung. In the lung the clot
blocks an artery and prevents the part of the lung that is supplied by the
artery from working normally. If the artery that is blocked is a large artery,
the embolus can cause sudden death. Patients undergoing hip replacement and
other major surgery are at increased risk of deep vein thrombosis and pulmonary
embolism. Dalteparin, like other LMWHs is derived from breaking heparin into
smaller units. Dalteparin prevents clot formation by accelerating the breakdown
of clotting factors Xa and IIa (thrombin) by antithrombin III. Unfractionated
heparin, unlike LMWHs, also breaks down clotting factors IX, XI, XII, and
plasmin. Unlike heparin, the effect of dalteparin does not need to be monitored
with blood tests. The FDA approved dalteparin in December 1994.
What brand names are available for dalteparin injection?
Fragmin
Is dalteparin injection available as a generic drug?
No
Do I need a prescription for dalteparin injection?
Yes
What are the side effects of dalteparin injection?
The most frequent adverse reactions are:
- bleeding,
- drop in platelet count,
- bruising,
- pain at injection site, and
- increase in certan factors inliver function tests.
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.
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What is the dosage for dalteparin injection?
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.
Which drugs or supplements interact with dalteparin injection?
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.
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Is dalteparin injection safe to take if I’m pregnant or breastfeeding?
Adverse effects were not observed in animal studies, as LMWHs do
not cross the placenta. LMWHs are preferred over unfractionated heparin and
warfarin
(Coumadin) in women
who are pregnant. Agents should be discontinued at least 24 hours
before planned delivery.
Dalteparin enters
breast milk, though oral absorption by the
infant is extremely low. The effect of this low level of exposure on the infant
is unknown.
What else should I know about dalteparin injection?
What preparations of dalteparin injection are available?
- 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
How should I keep dalteparin injection stored?
Store at room temperature, between 20 C to 25 C (68 F to 77 F).