fondaparinux (Subcutaneous route)

Pronunciation

fon-da-PAR-in-ux

Subcutaneous route(Solution)

Epidural or spinal hematomas, which may result in long-term or permanent paralysis, can occur in patients who are anticoagulated with low molecular weight heparins, heparinoids, or fondaparinux sodium and are receiving neuraxial anesthesia or undergoing spinal puncture. Use of indwelling epidural catheters, concomitant use of drugs affecting hemostasis (eg, NSAIDs, platelet inhibitors, or other anticoagulants), history of traumatic or repeated epidural or spinal puncture, spinal deformity, or spinal surgery may increase the risk of developing these hematomas. Monitor patients frequently for neurological impairment. If neurological compromise is noted, urgent treatment is necessary .

Commonly used brand name(s)

In the U.S.

  • Arixtra

Available Dosage Forms:

  • Solution

Therapeutic Class: Anticoagulant

Pharmacologic Class: Factor Xa Inhibitor

Uses For fondaparinux

Fondaparinux is used to prevent deep vein thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs. These blood clots can travel to the lungs and can become lodged in the blood vessels of the lungs, causing a condition called pulmonary embolism. fondaparinux is used for several days after hip fracture surgery, hip or knee replacement surgery, and in some cases following abdominal surgery, while you are unable to walk. It is during this time that blood clots are most likely to form.

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Fondaparinux is also used together with warfarin to treat acute deep vein thrombosis (blood clot in the leg) and pulmonary embolism (blood clot in the lung).

fondaparinux is available only with your doctor's prescription.

Before Using fondaparinux

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For fondaparinux, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to fondaparinux or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of fondaparinux in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of fondaparinux in the elderly. However, elderly patients are more likely to have bleeding problems and age-related kidney disease, which may require caution or an adjustment in the dose for patients receiving fondaparinux.

Pregnancy

Pregnancy Category Explanation
All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking fondaparinux, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using fondaparinux with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abciximab
  • Aceclofenac
  • Acemetacin
  • Alipogene Tiparvovec
  • Alteplase, Recombinant
  • Amtolmetin Guacil
  • Anistreplase
  • Apixaban
  • Argatroban
  • Aspirin
  • Bivalirudin
  • Bromfenac
  • Bufexamac
  • Celecoxib
  • Chamomile
  • Choline Salicylate
  • Citalopram
  • Clonixin
  • Clopidogrel
  • Collagenase, Clostridium histolyticum
  • Dabigatran Etexilate
  • Dalteparin
  • Danaparoid
  • Desvenlafaxine
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Drotrecogin Alfa
  • Enoxaparin
  • Eptifibatide
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenofibrate
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Garlic
  • Ginkgo
  • Ibuprofen
  • Ibuprofen Lysine
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Levomilnacipran
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Milnacipran
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxyphenbutazone
  • Papaya
  • Parecoxib
  • Paroxetine
  • Pentosan Polysulfate Sodium
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pranoprofen
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Reteplase, Recombinant
  • Rivaroxaban
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sodium Salicylate
  • St John's Wort
  • Streptokinase
  • Sulindac
  • Tan-Shen
  • Tenecteplase
  • Tenoxicam
  • Tiaprofenic Acid
  • Ticlopidine
  • Tirofiban
  • Tolfenamic Acid
  • Tolmetin
  • Urokinase
  • Valdecoxib
  • Venlafaxine
  • Vorapaxar
  • Vortioxetine

Using fondaparinux with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Avocado
  • Chondroitin
  • Coenzyme Q10
  • Curcumin
  • Dong Quai
  • Ginger
  • Vitamin A

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of fondaparinux. Make sure you tell your doctor if you have any other medical problems, especially:

  • Blood disease or bleeding problems or
  • Blood vessel problems or
  • Catheter insertion in the spine or
  • Diabetic retinopathy (eye problem) or
  • Hypertension (high blood pressure), uncontrolled or
  • Stomach or intestinal ulcer, active or
  • Stroke, recent or history of or
  • Surgery (e.g., eye, brain, or spine), recent or history of—Use with caution. The risk of bleeding may be increased.
  • Heart infection or
  • Weight of less than 110 pounds or
  • Kidney disease, severe or
  • Major bleeding, active or
  • Thrombocytopenia (low platelet count in the blood) or
  • Weight of less than 110 pounds—Should not be used in patients with these conditions.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal from the body.

Proper Use of fondaparinux

A nurse or other trained health professional will give you fondaparinux. fondaparinux is given as a shot under your skin, usually in the abdomen.

fondaparinux comes with a patient information insert. Read and follow the instructions in the insert carefully. Ask your doctor if you have any questions.

If you are using fondaparinux at home, your doctor will teach you how to inject yourself with the medicine. Be sure to follow the directions carefully. Check with your doctor if you have any problems using the medicine.

You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas. This will help prevent skin problems from the injections.

If the medicine in the prefilled syringe has changed color, or if you see particles in it, do not use it.

Dosing

The dose of fondaparinux will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of fondaparinux. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form:
    • For prevention of deep vein thrombosis:
      • Adults—2.5 milligrams (mg) injected under the skin once a day for 5 to 9 days. The first dose is given 6 to 8 hours after surgery.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of deep vein thrombosis and pulmonary embolism:
      • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 5 to 10 milligrams (mg) injected under the skin once a day for 5 days.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of fondaparinux, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Precautions While Using fondaparinux

It is very important that your doctor check your progress at regular visits to make sure fondaparinux is working properly. Blood tests will be needed to check for unwanted effects. Be sure to keep all appointments.

Fondaparinux may cause bleeding problems. This risk is higher if you have a catheter in your back for pain medicine or anesthesia (sometimes called an "epidural"), or if you have kidney problems. The risk of bleeding increases if your kidney problems get worse. Check with your doctor right away if you have any unusual bleeding or bruising; black, tarry stools; bleeding gums; blood in the urine or stools; tingling, numbness, or weakness of the lower legs; or pinpoint red spots on your skin.

You may bleed or bruise more easily while you are using fondaparinux. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Be careful when using sharp objects, including razors and fingernail clippers. Avoid nose picking and forceful nose blowing.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Make sure any doctor or dentist who treats you knows that you are using fondaparinux. You may need to stop using fondaparinux several days before having surgery or medical tests.

Also, tell your doctor if you have received fondaparinux or heparin before and had a reaction called thrombocytopenia (low platelet count in the blood), or if new blood clots formed while you were receiving the medicine.

The needle guard of the prefilled syringe of fondaparinux contains dry natural latex rubber. Tell your doctor if you have any allergies with latex or rubber.

Check with your doctor before you start or stop taking any other medicine, or change the amount you are taking. This includes prescription or nonprescription (over-the-counter [OTC]) medicines, and herbal or vitamin supplements. Many medicines change the way fondaparinux affects your body.

fondaparinux Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Pale skin
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Less common
  • Black, tarry stools
  • bladder pain
  • bleeding
  • bleeding gums
  • blood in the urine or stools
  • blurred vision
  • chest pain
  • chills
  • collection of blood under the skin
  • confusion
  • convulsions
  • cough
  • decreased or cloudy urine
  • deep, dark purple bruise
  • difficult, burning, or painful urination
  • dizziness
  • dry mouth
  • fainting or lightheadedness when getting up from a lying or sitting position
  • fever
  • frequent urge to urinate
  • increased thirst
  • irregular heartbeat
  • itching, pain, redness, or swelling at the place of injection
  • loss of appetite
  • lower back or side pain
  • mood changes
  • muscle pain or cramps
  • nausea or vomiting
  • numbness or tingling in the hands, feet, or lips
  • pinpoint red spots on the skin
  • red, tender, or oozing skin at incision
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • sudden sweating

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
  • Abdominal or stomach pain or swelling
  • bruising or purple areas on the skin
  • coughing up blood
  • decreased alertness
  • headache
  • joint pain or swelling
  • nosebleeds

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Difficulty having a bowel movement
  • rash
  • sleeplessness
  • swelling
  • trouble sleeping
Less common
  • Acid or sour stomach
  • belching
  • diarrhea
  • heartburn
  • indigestion
  • pain
  • skin blisters
  • stomach discomfort, upset, or pain
  • tightness in the chest
  • unusual changes to site of surgery
  • wheezing
  • wound drainage, increased

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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