Dalteparin (Subcutaneous Route)

Dalteparin is a heparin, an anticoagulant used to prevent deep venous thrombosis or blood clots. It works by thinning the blood. It is also known as Fragmin.

Overview

Dalteparin stops the formation of blood clots in patients who have had heart attacks or unstable angina. It can also be used to prevent blood clots during times when patients cannot walk, such as after hip replacement surgery or abdominal surgery. Patients with cancer may take Dalteparin for long-term prevention of blood clots.

Deep venous thrombosis occurs when harmful blood clots form inside blood vessels of the legs. These blood clots can move into the lungs and prevent blood flow in blood vessels in the lungs, which causes pulmonary embolism, a condition which can become fatal.

Conditions Treated:

  • Blood clots
  • Deep venous thrombosis

Type of Medicine:

  • Heparin
  • Anticoagulant

Side Effects

Mild Side Effects

While taking Dalteparin, you may experience some mild side effects that are simply the result of your body adjusting to the medication. These side effects do not usually require medical intervention, and should subside or go away during the course of the treatment or after the treatment has been finished. If these symptoms get worse, do not subside, or become bothersome, let your health care professional know as soon as possible. Your doctor or other health care professional may be able to suggest some courses of treatment that can help you alleviate these symptoms.

Patients taking Dalteparin may experience low platelet levels, which can lead to bruising or bleeding. If you experience unusual bruising or bleeding while taking Dalteparin, let your doctor know.

Patients taking Dalteparin may experience pain, swelling, or bruising at the injection site where the needle went into the body. If this occurs, check with your doctor.

Serious Side Effects

In addition to the therapeutic effects for which Dalteparin has been prescribed, some patients may experience unwanted side effects. These side effects can be serious health problems if left untreated, or may be symptoms of health problems which may have been triggered by the Dalteparin. If you experience any of these symptoms, contact your doctor immediately to see if you need medical intervention or if you need to cease or reduce your dose of Dalteparin.

Some patients taking Dalteparin may experience dermatological side effects such as:

  • Pain, swelling, or deep, dark, purple bruises at the site of the injection
  • Unusual bruising patterns on the body
  • Redness, flushing, or bluish or black discoloration on the skin
  • Tickling, tingling, pricking, or burning sensations on the skin
  • Itching on the skin
  • A rash on the skin, which may consist of purple or red spots the size of pin points, or hives
  • Skin sloughing off at the injection site
  • Swelling in the face, especially on the eyelids or the lips

Some patients taking Dalteparin may experience hematological side effects such as:

  • Bleeding of the gums or bleeding from other mucous membranes on the body
  • Increased vaginal bleeding, menstrual flow, or breakthrough bleeding
  • Unexplained or sudden nosebleeds or increased nosebleeds
  • Prolonged bleeding from cuts
  • Coughing up blood

Some patients taking Dalteparin may experience eliminatory side effects such as:

  • Stools that are red, black, or tarry
  • Blood in the stool
  • Dark brown urine or red urine
  • Blood in the urine
  • Problems with normal bladder function or normal bowel function, such as not being able to urinate or defecate normally

Some patients taking Dalteparin may experience gastrointestinal side effects such as:

  • Vomiting of blood or of material that looks like coffee grounds
  • Some patients taking Dalteparin may experience respiratory side effects such as:
  • Difficulty with breathing or difficulty with swallowing
  • Coughing
  • Tightness in the chest

Some patients taking Dalteparin may experience other side effects such as:

  • Dizziness
  • Unusual headaches
  • Unexplained discomfort, swelling, or pain in the abdomen or stomach, the chest, the muscles, the joints, or elsewhere in the body
  • Unusual or chronic back pain
  • A feeling of faintness
  • A feeling of weakness
  • Weakness in the legs or muscles
  • Numbness in any area of the body
  • Fever
  • Paralysis

If you experience any of these side effects while talking Dalteparin, seek medical attention.

Dosage

The dosage of Dalteparin, as well as the scheduling of the doses and the duration of the treatment, will be different depending on the condition for which it has been prescribed and the strength of the medication you are using. The dosage and schedule given here is a standard dose provided by the manufacturer. Each patient's dose will be unique based on their needs. When in doubt about the dose or schedule of your medication, refer to your doctor's directions first. Do not change your dose unless instructed by your doctor.

Dalteparin is given by subcutaneous injection. If administered in a hospital, doctor's office, or another clinical setting, a trained health care professional will give you the injection under your skin in the abdomen, thighs, buttocks, or another suitable body part. For patients who use Dalteparin at home, your health care professional will show you the correct method to manage the administration. Follow all given directions precisely, and check with your health care professional if you have any questions about using the medication. Your health care professional will show you the areas on your body where it is safe to give this shot. Be sure to rotate where you administer the shot each time you take it, and keep a log of the areas where you have given yourself a shot so you do not repeat areas too often. This can help to prevent some of the dermatological or skin-related side effects from the injection.

Patients taking Dalteparin in order to prevent blood clots from forming after unstable angina (i.e. chest pain) or a non Q-wave myocardial infarction (a category of heart attack) will take 120 international units per kilogram of your body weight, up to but not any more than 10,000 international units. This dosage is administered under the skin and is to be given for 5 to 8 days, every 12 hour. This will be administered along with 75 to 165 milligrams of aspirin unless your doctor directs otherwise.

Patients talking Dalteparin in order to prevent deep venous thrombosis after surgery on the abdomen will take 2,500 or 5,000 international units injected under the skin once per day, or 2,500 international units which are to be injected under the skin, to be followed by 2,500 more international units of the medication 12 hours after, after which 5,000 international units should be injected under the skin for 5 to 10 days once per day.

To prevent deep venous thrombosis after surgery to replace a hip, there are several ways to administer Dalteparin. If you start your regimen the day before your surgery, you will take 5,000 international units under the skin, which will be followed by 5,000 international units administered in the same fashion 4 to 8 hours after your surgery. If Dalteparin is to be started the day you have your surgery, you will receive 2,500 international units injected under the skin 2 hours before your surgery, and then 2,500 international units administered in the same fashion 4 to 8 hours after your surgery. If the Dalteparin is started after the surgery is done, you will receive 2,500 international units 4 to 8 hours after your surgery, injected under the skin. These will be followed by an injection of 5,000 international units of Dalteparin once per day for 5 to 10 days after your surgery.

For preventing pulmonary embolism or deep venous thrombosis in patients who have cancer, the first month of your Dalteparin regimen will see 200 international units per kilogram of your total body weight, up to 18,000 international units, injected under your skin once per day for the first month. For the next 5 months after the first month of your Dalteparin regimen, you will receive 150 international units per kilogram of your body weight injected under your skin once per day.

For preventing deep venous thrombosis in other medical patients, you will take 5,000 international units of Dalteparin that will be injected under your skin once per day for 12 to 14 days.

In all cases of Dalteparin dosage for children, the prescribing physician will decide the dosage and schedule.

If you forget one dose of your Dalteparin, you will need to inject the dose or have your dose injected as soon as you can. If it is nearly time for you to take the next dose of Dalteparin, skip the dose that you missed and stay on your regular schedule of medication. Do not take a double dose of Dalteparin, or your risk of side effects may be increased.

Interactions

Drug interactions can increase your risk of side effects from any drug you are taking, and can make your medications work differently, reducing their therapeutic benefit to you. It is important to understand your risk of drug interaction and minimize it when possible. Keep a list of any drug, medication, or supplement you take on a regular basis, whether it is prescribed to you by a health care professional or taken over the counter. Your pharmacist, doctor, or other health care professional will be able to identify potential interactions between Dalteparin and the other substances you are taking.

Dalteparin can interact with other drugs that increase the risk of bleeding, such as aspirin, warfarin, or any other medications that function as blood thinners. Dalteparin can interact with drugs that are used to prevent or treat blood clots. Before taking Dalteparin, tell your doctor about any medication you are using that is meant to treat or prevent blood clots.

Warnings

Interaction with Health Care Professionals

Dalteparin may have side effects which do not manifest in the body as physical symptoms, but will show up on blood tests and other laboratory tests. It is crucial for the effective use of this medication that your doctor keep tabs on your progress. Keep regular doctor's appointments while using Dalteparin so your doctor is able to monitor your progress and check for any side effects.

Make sure that any doctor, dentist, or other health care professional knows whether you are currently taking Dalteparin. If you are scheduled to have medical tests or surgery, you might need to cease using this medication a few days before the scheduled procedure. Consult with your prescribing physician and any other health care professional involved for the correct way to proceed in this situation.

Bleeding and Bruising

Dalteparin can increase your risk of bruising and bleeding. Your risk of problematic bruising or bleeding is larger if you have had a heart infection, stomach ulcers, high blood pressure that has not been well controlled, or any other problems involving bleeding. Consult with your health care professional before taking Dalteparin to see if this medication is right for you.

While on Dalteparin, there are some things you can do to take precautions against bleeding. Take caution when you are cleaning your teeth if you use a normal toothbrush, a toothpick, or dental floss. Check with your supervising physician before any you get any dental work performed. Your doctor, nurse, or a dentist may suggest some ways you can clean your mouth, teeth, and gums without heightening the risk of bleeding. When you are grooming yourself, be careful when you use fingernail cutters, toenail cutters, or shaving yourself with a straight or safety razor. Consider getting help if you are experiencing symptoms such as shakiness or dizziness. Avoid situations such as contact sports where injury or bruising has a chance of occurring, even slight bruising or injury. When blowing your nose, make sure you are gentle during the process.

Take note of your side effects while using Dalteparin. Check with your doctor if you experience any unusual bruising or bleeding, red spots on your skin the size and shape of a pinpoint, blood in the urine or the stool, or stools that are black and tarry.

Spinal Problems

Dalteparin can increase the chances of nerve issues in the spine or of serious bleeding in the spine. The risk of these problems is heightened if you've got an injection in your spine, known as an epidural or a spinal, or if you have a catheter in your back that is used to inject anesthetics or pain medication. You are also at a higher risk for these problems if you have had repeated or traumatic spinal punctures or epidurals previously, if you have or previously have had any kind of spinal deformity, if you have had any kind of surgery on your spine, or if you are currently using any other medications which come with an increased risk of bleeding.

Some early symptoms of spinal problems which Dalteparin may cause include numbness or weakness in your feet or legs, as well as incontinence of either stools or urine. If you experience any of these symptoms while taking Dalteparin, contact your doctor immediately.

Thromboembolism

Dalteparin can increase the risk of thromboembolism. This occurs when a blood vessel is blocked by a blood clot that has been dislodged from another site in your body, and can be fatal. Symptoms of a thromboembolism include:

  • Pain in your groin, chest, or legs, especially in the calves
  • A severe and sudden headache
  • Difficulty in breathing
  • Sudden shortness of breath
  • Sudden and severe numbness in the leg or arm
  • Sudden and severe weakness in the leg or arm
  • Sudden loss of coordination
  • Vision changes

If you experience any of these symptoms while talking Dalteparin, contact your doctor immediately and seek medical assistance.

Changes in the Medication

Keep track of the appearance of your Dalteparin. If the medicine in the prefilled syringe or glass bottle you use has changed appearance, such as changing color, or has particles or other detritus in it, do not use it. Check with your doctor or pharmacist for disposal instructions and replacement medication.

Storage

Dalteparin is normally stored in multiple-dose vials, which may be stored at room temperature for up to two weeks after the first time the rubber stopper penetrates the vial. Single-dose vials should be stored at room temperature as well. Dalteparin keeps best at temperatures from 68° to 77°F, and may be briefly exposed to temperatures no colder than 59°F to no warmer than 86°F. Keep the medicine in a closed container and keep it away from direct light, moisture, or heat.

Keep Dalteparin out of the reach of children. Throw away any used needles in a closed container made of hard material that the needles cannot poke through, and keep this container out of the reach of pets or children.

If you have completed your regimen of Dalteparin and have extra medication you cannot use, do not keep your medication. If you have medication that is past its effective expiration date, do not keep your medication. If you received a bottle of medication meant to be used along with your syringes, you will need to use that medicine within 14 days after you first open the medication. After 14 days, throw away any of the medication remaining in the bottle that you have not used. Ask your healthcare professional how to safely dispose of any medication you have not used. Your pharmacy may participate in a safe medication disposal program.

Summary

Dalteparin, also known as Fragmin, is a heparin anticoagulant used to prevent deep venous thrombosis or blood clots. It is injected subcutaneously, under the skin, in a clinical setting such as a hospital room or at home.

Patients who have had unstable angina, heart attacks, or cancer may take this drug to prevent blood clots. Patients who are unable to walk after surgery, such as after abdominal surgery or hip replacement surgery, may also take this drug to prevent blood clots.

Dalteparin can lead to low platelet levels, which can lead to bruising or bleeding. Be careful to avoid situations which may lead to bruising or bleeding while taking this medication. Dalteparin can sometimes cause internal bleeding. Contact your doctor if you experience signs of internal bleeding such as vomit in the blood, stool, or urine, or coughing up blood.

Dalteparin can lead to nerve damage or spinal bleeding. This risk is heightened if you have had previous spinal damage or trauma. Contact your doctor if you experience numbness or weakness in the legs or incontinence.

Dalteparin can increase the risk of thromboembolism, which occurs when a blood vessel is blocked by a dislodged blood clot. Symptoms of thromboembolism include pain, weakness or numbness in the legs, groin, or chest, a sudden headache, difficulty breathing, a sudden loss of coordination, or vision changes. Get medical assistance if you experience these symptoms.

Dalteparin can lead to allergic reactions. Contact your doctor if you experience unusual pain, swelling, or redness at the injection site, or a skin rash or irritation near the injection site or anywhere on the epidermis.