Fondaparinux (Subcutaneous)

Fondaparinux is an anticoagulant prescribed to prevent deep vein thrombosis. It is chemically similar to heparin.

Overview

Deep vein thrombosis occurs when blood clots form in the blood vessels of the legs. These blood clots may be carried into the small blood vessels of the lungs, where they can become lodged. This causes a pulmonary embolism, which can be life-threatening. Deep vein thrombosis usually occurs when a patient has been unable to walk for an extended period of time, such as after a surgery. Anticoagulants such as Fondaparinux help prevent these blood clots by reducing the clotting mechanism of the body.

Fondaparinux is prescribed to patients who have recently had surgery for a hip fracture, surgery to replace a hip or knee, or surgery on the stomach or abdomen. It is used for several days after the surgery, when patients are unable to walk. Fondaparinux may also be prescribed along with warfarin to treat patients who have had acute deep vein thrombosis or blood clots in the leg, and pulmonary embolism or blood clots in the lungs.

Fondaparinux is given by subcutaneous injection, or injection under the skin. It is only available with a doctor's prescription, and comes as a solution for injection or in pre-loaded syringes for injection.

Conditions Treated

  • Deep vein thrombosis
  • Pulmonary embolism

Type Of Medicine

  • Anticoagulant

Side Effects

Mild Side Effects

Some patients taking Fondaparinux may experience mild unwanted side effects in addition to the therapeutic effects for which it was prescribed. These side effects are a result of your body adjusting to the new medication, and usually do not require medical attention. If these side effects become worse, do not subside over the course of the treatment, or become bothersome, contact your doctor. Your doctor may be able to suggest some courses of treatment that can help reduce or ameliorate these side effects.

Some patients taking Fondaparinux may experience mild gastrointestinal side effects such as:

  • Sour stomach or acid stomach
  • Indigestion or heartburn
  • Excess belching
  • Indigestion
  • Diarrhea or constipation
  • Difficulty having a bowel movement
  • Pain or discomfort in the stomach
  • Upset stomach

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

  • Blisters on the skin
  • Unusual swelling
  • Unusual pain
  • Difficulty sleeping
  • Tightness in the chest
  • Increased wound drainage
  • Unusual changes to the site of your surgery

Serious Side Effects

Some patients taking Fondaparinux may experience more serious side effects in addition to the therapeutic effects for which the medication was prescribed. These side effects may lead to serious health problems, or might be symptoms of serious health problems which may have been triggered by the Fondaparinux. If you experience these side effects, you will need medical attention and to contact your doctor immediately.

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

  • A loss of appetite
  • Nausea or vomiting

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

  • Bladder pain
  • Cloudy urine
  • A frequent need to urinate
  • Increased thirst
  • Dry mouth
  • Urination that is painful or burning
  • Difficulty in urination
  • Decreased output or frequency of urine
  • Blood in the urine or in the stool
  • Stools that are black or dark and have a tarry consistency
  • Bladder dysfunction
  • Bowel dysfunction

Some patients taking Fondaparinux may experience respiratory side effects such as:

  • Trouble breathing when you exert yourself
  • Pain in the chest
  • A cough
  • Shortness of breath
  • A sore throat
  • Difficulty with swallowing (because of pain or irritation in the throat)
  • Tightness in the chest

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

  • Pale skin
  • Swelling, itching, pain, or redness of the skin around the injection site
  • Red spots on the skin that look like pinpoints
  • Tender, red, or oozing skin at the point of incision
  • Ulcers, sores, or white spots in or around the mouth and lips
  • Itching of the skin
  • A skin rash
  • Hives on the skin
  • Large swellings similar to hives on the face, eyelids, tongue and throat, hands, feet, legs, or genitalia
  • Swelling or puffiness of the eyelids or in the face around the eyes, lips, or tongue

Some patients taking Fondaparinux may experience neurological side effects such as:

  • Unusual tiredness or weakness
  • Blurred vision
  • Confusion
  • Convulsions or seizures
  • Dizziness
  • A lightheaded feeling or fainting when getting up from a prone or sitting position
  • Tingling or numbness in the hands, lips, or feet
  • Weakness of the legs
  • Numbness
  • Paralysis

Some patients taking Fondaparinux may experience bleeding side effects such as:

  • Unusual bleeding or bruising
  • Bleeding gums
  • A deep, dark, purple bruise on the skin
  • A collection of blood under the skin or subcutaneous bleeding

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

  • Chills
  • A fever
  • An irregular heartbeat
  • Sudden sweating
  • Pain in the back
  • A fast heartbeat

Dosage

The dosage and scheduling information given here is a standard provided by the manufacturer. When using Fondaparinux, always follow your doctor's dosage, usage, and scheduling instructions. The dose of medication given and the schedule of dosage will be different depending on the condition for which the Fondaparinux is prescribed and the strength of the medication used, as well as your doctor's determination of your condition and needs. The dose of Fondaparinux for children will vary from the dose of Fondaparinux for adults.

Fondaparinux may be administered at home or at a clinic. If the medication is being administered at a medical facility, a trained medical professional such as a nurse will give this medication as a shot under the skin, normally in the stomach or the abdomen.

If you are using Fondaparinux at home, your doctor or health care professional will show you the proper procedure for injecting the medication. Your doctor will show you the parts of your body where it is safe and most effective to inject your dose of Fondaparinux. You will need to inject Fondaparinux into a different part of the body each time you give yourself a dose of this medication. Keep careful track of where you inject your dose and be sure to rotate the area in order to prevent unwanted side effects or skin problems.

Patients taking Fondaparinux to prevent an incidence of deep vein thrombosis after a stomach surgery or abdominal surgery will receive a dose of 2.5 milligrams of Fondaparinux injected subcutaneously, with the first dose being administered 6 to 8 hours after the surgery has ended. This dose will be given once per day for 5 to 9 days.

Patients taking Fondaparinux to prevent an incidence of deep vein thrombosis after hip replacement surgery, knee replacement surgery, or hip fracture surgery will receive 2.5 milligrams of Fondaparinux injected subcutaneously 6 to 8 hours after the surgery has finished. This dose will be repeated once per day for 5 to 9 days.

Patients taking Fondaparinux to prevent an incidence of deep vein thrombosis and pulmonary embolism will receive a dose that is based on their body weight, injected subcutaneously once per day for a minimum of 5 days. This dose of Fondaparinux is usually between 5 to 10 milligrams, but will depend on body weight and other factors determined by the doctor.

If you miss a dose of your Fondaparinux, take it as soon as you remember and are able to. If it is nearly time for you to take your next dose of Fondaparinux, skip the missed dose and take the next dose at the scheduled time. Do not double dose Fondaparinux. If you are not sure of a safe interval between doses, contact your doctor.

Interactions

Drug interactions may change the way your needed medication works in your body, or heighten your risk of unwanted side effects from your medication. Keep a complete list of the medications, drugs, and supplements you take on a regular basis, whether they have been prescribed to you by a doctor or are taken over the counter. Your doctor or pharmacist will be able to alert you to any drug interactions and counsel you. Do not start, stop, or change the dosage of a medication until you have checked with your doctor.

Fondaparinux is most likely to interact with drugs that increase your risk of bleeding, thin your blood, or have other effects on your bloodstream. While you are taking Fondaparinux, check the labels on your prescription drugs or any drugs or supplements taken over the counter to see whether they contain ingredients which may interact with Fondaparinux. Check with your doctor before taking any medications or drugs which contain:

  • Common NSAIDs such as ibuprofen, aspirin, or naproxen
  • Prescription NSAIDs such as ketorolac
  • Mifepristone
  • Blood thinners such as rivaroxaban
  • Antiplatelet drugs such as clopidogrel

Warnings

Progress Checks

While taking Fondaparinux, you will need to keep regular appointments with your doctor. Make sure you do not skip these appointments. Your doctor will need to perform regular checkups on you during the course of your treatment with Fondaparinux to make sure the medication is working correctly. Your doctor will also need to take regular blood tests from you to make sure that the medication is not having unwanted effects. Some side effects of Fondaparinux may not show up right away as symptoms, and regular blood tests can catch unwanted effects of Fondaparinux before they have a more serious impact on your health.

Medical History

The use of Fondaparinux may not be advised for all patients. Before you start to use Fondaparinux, make sure your doctor knows your medical history. Conditions that may heighten your risk of serious side effects or other unwanted effects while using Fondaparinux include:

  • High blood pressure
  • Kidney disease
  • Seizures or epilepsy
  • Intestinal or stomach problems such as colitis or recent ulcers
  • A history of infection in the heart, or bacterial endocarditis
  • Past problems with blood clotting because of the use of heparin, or heparin-induced thrombocytopenia
  • Bleeding problems or blood problems such as low platelets or a blood count
  • A low platelet count that resulted from antiplatelet antibodies
  • Any current problems you have with serious bleeding, such as a bleeding ulcer
  • Certain eye problems such as diabetic retinopathy
  • A stroke
  • Recent surgery, especially surgery performed on the spine, brain, or eye
  • A recent spinal puncture, spinal tap, or other spinal procedures
  • Spinal problems such as a deformity of the spine
  • Low adult body weight (defined as being under 110 pounds)

Bleeding Problems

Fondaparinux is an anticoagulant, and as such may increase your risk of bleeding problems or uncontrolled bleeding. While you are using Fondaparinux, cuts or small injuries may trigger large bruises or cause other problems. There are some precautions you can take to reduce your risk of uncontrolled bleeding or serious injury while taking Fondaparinux:

  • Stay away from contact sports or other situations which may cause bruising, bleeding, or injury
  • Limit the use of alcoholic drinks, which can heighten your risk of stomach bleeding
  • Avoid picking the nose or blowing the nose with force
  • Be careful when using sharp objects near the skin, such as fingernail clippers or safety razors
  • Be careful when using dental floss, a toothpick, or regular toothbrush
  • Ask your doctor, dentist, or other medical health professional to recommend safer ways to clean the teeth and gums
  • Check with your medical doctor before any dental work is performed
  • Make sure your doctor or dentist knows you are using Fondaparinux and have a heightened risk of bleeding
  • Check with your doctor before you have any medical tests or surgery done to see if you need to stop taking Fondaparinux before your tests or surgery

Bleeding Problems for Patients with Catheters or Kidney Problems

The risk of experiencing certain bleeding problems from taking Fondaparinux is heightened for patients who have had kidney problems, as well as for patients who have a catheter in the back for anesthesia or pain medicine (such as an epidural). If the kidney problem worsens while taking Fondaparinux, the risk of bleeding heightens as well. Contact your doctor immediately if you experience any symptoms that include:

  • Unusual bleeding or bruising
  • Bleeding gums
  • Blood in the urine
  • Blood in the stool
  • Stools that are black with a tarry consistency
  • Red spots on the skin in the shape of pinpoints
  • Numbness, weakness, or tingling in the lower legs

Blood Clotting

Patients who have a history of spinal surgery, a genetic spinal defect, or patients who have had repeated spinal taps or spinal catheters are at a heightened risk of experiencing blood clots around the spine while using Fondaparinux. The risk of experiencing epidural or spinal blood clots may also be increased with the use of certain medical procedures and some medications. These blood clots are very serious and can be life-threatening. Patients experiencing symptoms of a spinal or epidural blood clot while using Fondaparinux will need medical attention. Contact your doctor immediately if you experience symptoms of a spinal blood clot such as:

  • Midline back pain or pain in the middle of the back
  • Weakness, tingling, or numbness in the feet or the legs
  • Incontinence or loss of bladder or bowel control

Previous Reactions

Fondaparinux or heparin medications may cause a reaction called thrombocytopenia in some patients. This occurs when the blood has a low platelet count. These medications may also cause new blood clots to form in some patients. If you have used Fondaparinux or a heparin medication before and experienced a low platelet count or the formation of new blood clots during the use of either of these medications, let your doctor know before you start to use Fondaparinux again.

Latex Allergies

Fondaparinux comes in several forms including a prefilled syringe. The needle guard on this syringe is made out of a material that contains dry natural latex rubber. If you have an allergy to rubber or any latex allergies, tell your doctor before you start taking Fondaparinux.

Pregnancy

Fondaparinux may not be safe for pregnant patients. Taking Fondaparinux while pregnant may lead to problems during pregnancy. If you are pregnant or plan to become pregnant in the near future or while taking Fondaparinux, talk to your doctor before starting a regimen of Fondaparinux. If you find you have become pregnant while taking Fondaparinux, talk to your doctor. Your doctor will be able to discuss the risks and benefits to you and your child if you plan to take Fondaparinux while pregnant.

Fondaparinux may pass into breast milk. If you are nursing or plan to nurse an infant while using Fondaparinux, talk to your doctor about ways you can reduce the risk of passing Fondaparinux to your infant.

Storage

Store Fondaparinux in its original container or in a tightly closed container, out of the reach of children and pets. Do not expose Fondaparinux to freezing, extreme heat, direct light, or moisture.

Do not keep Fondaparinux that you no longer need. Do not keep Fondaparinux if it is out of date. Do not keep Fondaparinux if the prefilled syringe has particles floating in the liquid, or if the liquid inside has changed color.

Used syringes can be dangerous. Keep all used syringes from your Fondaparinux in a hard container that needles will not be able to poke through. Make sure the container is kept closed and kept safe from children or pets. Ask your doctor or pharmacist how to safely dispose of used needles or unused Fondaparinux.

Summary

Fondaparinux is an anticoagulant, similar to heparin, prescribed to prevent and treat deep vein thrombosis and pulmonary embolism. It is administered subcutaneously, and may be given in a clinical setting or at home.

Fondaparinux is usually prescribed to patients recovering from hip, knee, stomach, or abdominal surgery in order to prevent blood clots from forming in the leg and traveling to the lungs during periods of inactivity following surgery. It may also be prescribed along with warfarin to patients who have experienced deep vein thrombosis or pulmonary embolism.

Fondaparinux is normally injected under the skin once per day. Patients who take Fondaparinux to prevent deep vein thrombosis after surgery will usually receive a 2.5 mg dose of Fondaparinux 6 to 8 hours after the surgery is done and receive a repeated dose for 5 to 9 days. Patients who take Fondaparinux after an incidence of deep vein thrombosis or pulmonary embolism will receive a dose of between 5 to 10 mg of Fondaparinux, based on their body weight, injected under the skin once a day for at least 5 days.

Fondaparinux may cause some mild side effects that do not usually need medical attention. These side effects include indigestion or heartburn, diarrhea or constipation, excess belching, stomach pain or discomfort, insomnia, blisters or swelling on the skin, tightness in the chest, or increased wound drainage. If these side effects persist or become bothersome, contact your doctor.

Fondaparinux may cause some more serious side effects which need medical attention. Some patients may experience nausea or vomiting, bladder pain or painful urination, difficult urination or frequent urination, blood in the urine or the stool, or bladder or bowel dysfunction. Some patients may experience chest pain, shortness of breath, a sore throat, pinpoint red spots on the skin, ulcers or sores on the skin, hives or a rash on the skin, puffiness or swelling of the skin, or large swellings on the extremities. Some patients may experience weakness or tiredness, confusion, blurred vision, lightheadedness or dizziness, tingling or numbness, paralysis, unusual bleeding or bruising, bleeding gums, chills or a fever, a fast or irregular heartbeat, or sudden sweating. If you experience these side effects while taking Fondaparinux, contact your doctor immediately.

Fondaparinux may cause uncontrolled bleeding. Avoid activities that may cause bruising, bleeding, or injury while using Fondaparinux. Check with your doctor while taking Fondaparinux with any medication that thins the blood, such as anticoagulants or NSAIDs.