Dalteparin Dosage

This dosage information may not include all the information needed to use Dalteparin safely and effectively. See additional information for Dalteparin.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Abdominal Surgery

2500 international units subcutaneously once a day, beginning 1 to 2 hours prior to surgery and continuing for 5 to 10 days postoperatively.

Usual Adult Dose for Venous Thromboembolism

First 30 days of therapy: approximately 200 international units/kg ABW, not to exceed 18,000 international units subcutaneously once daily for the first 30 days of therapy. The following doses should be given based on patient weight:
56 kg or less: 10,000 international units subcutaneously once daily
57 to 68 kg: 12,500 international units subcutaneously once daily
69 to 82 kg: 15,000 international units subcutaneously once daily
83 to 98 kg: 18,000 international units subcutaneously once daily
99 kg or more: 18,000 international units subcutaneously once daily

For months 2 to 6: approximately 150 international units/kg ABW, not to exceed 18,000 international units subcutaneously once daily should be given. The following doses should be given based on patient weight:
56 kg or less: 7500 international units subcutaneously once daily
57 to 68 kg: 10,000 international units subcutaneously once daily
69 to 82 kg: 12,500 international units subcutaneously once daily
83 to 98 kg: 15,000 international units subcutaneously once daily
99 kg or more: 18,000 international units subcutaneously once daily

The daily dose of dalteparin should be reduced by 2,500 international units in patients with platelet counts between 50,000 and 100,000/mm3 until the platelet count recovers to greater than or equal to 100,000/mm3. In patients who experience platelet counts less than 50,000/mm3, dalteparin should be discontinued until the platelet count recovers above 50,000/mm3.

Safety and efficacy beyond six months has not been evaluated in patients with cancer and acute symptomatic venous thromboembolism.

Usual Adult Dose for Myocardial Infarction

120 international units/kg (not to exceed 10,000 international units) subcutaneously every 12 hours with concurrent aspirin therapy for 5 to 8 days.

Usual Adult Dose for Angina Pectoris

120 international units/kg (not to exceed 10,000 international units) subcutaneously every 12 hours with concurrent aspirin therapy for 5 to 8 days.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Orthopedic Surgery

2500 international units twice a day or 5000 international units once a day.

Usual Adult Dose for Deep Vein Thrombosis - Prophylaxis

5000 international units subcutaneously once a day. The usual duration of administration in clinical trials was 12 to 14 days.

Renal Dose Adjustments

Dalteparin should be administered cautiously to patients with renal dysfunction. It is recommended that the dosage of dalteparin be adjusted by monitoring antifactor Xa activity in patients with renal dysfunction.

Liver Dose Adjustments

The manufacturer recommends caution when administering this drug to patients with liver dysfunction.

Dose Adjustments

In patients requiring general surgery at higher risk of thromboembolism, dalteparin has been given in doses of 5000 international units the evening before surgery, and then 5000 international units each day postoperatively for 5 to 10 days. Alternatively, 2500 international units of dalteparin has been given 2 hours prior to surgery, then 2500 international units given 12 hours postoperatively, then 5000 international units once a day for 5 to 10 days.

Precautions

The use of dalteparin is contraindicated in patients with active major bleeding, with thrombocytopenia associated with a positive in vitro test for antiplatelet antibody in the presence of dalteparin, or with a known hypersensitivity heparin or pork products.

Patients undergoing spinal/epidural anesthesia or puncture and anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids are at risk for long-term or permanent paralysis due to epidural or spinal hematoma. The risk of these events is increased by use of indwelling epidural catheters or by concomitant use of platelet inhibitors, other anticoagulants, or drugs that affect hemostasis.

Heparin-induced thrombocytopenia rarely may occur with the use of dalteparin and patients should be monitored periodically for altered platelet counts. Dalteparin should be used with extreme caution in patients with a history of unfractionated heparin-induced thrombocytopenia.

Dalteparin should be used with extreme caution in patients in whom there is an increased danger of hemorrhage, including those with severe hypertension, bacterial endocarditis, congenital or acquired bleeding tendencies, hemophilia, some vascular purpuras, gastrointestinal ulcerations and angiodysplastic gastrointestinal disease, and severe liver disease with impaired hemostasis. Dalteparin should also be used cautiously in patients with retinopathy, thrombocytopenia, or kidney insufficiency. In addition, dalteparin should be used with caution during or immediately following major surgery involving the brain, spinal cord, or eyes.

Hemorrhage due to dalteparin overdose can generally be stopped by the slow intravenous injection of protamine sulfate (1% solution), at a dose of 1 mg protamine for every 100 anti-Xa international units of dalteparin given. A second infusion of 0.5 mg protamine per 100 anti-Xa international units of dalteparin may be given if the aPTT measured 2 to 4 hours after the first infusion remains prolonged. Only 60% to 75% of the antifactor Xa activity is completely neutralized, and the aPTT may remain prolonged more than would usually be found after heparin administration.

Dalteparin should not be given by intramuscular injection. Intramuscular injection of other medications should be avoided in patients receiving dalteparin due to an increased risk of bleeding and hematoma formation at the site of injection.

Dalteparin cannot be used interchangeably on a unit for unit basis with other low molecular weight heparins or unfractionated heparin.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

In patients with chronic renal insufficiency requiring hemodialysis, the elimination half-life of intravenous dalteparin ranges from 3.7 to 7.7 hours. Dalteparin may accumulate in these patients.

Other Comments

Dalteparin is frequently administered at a fixed dose without laboratory monitoring, especially when given prophylactically, and this is one of the primary advantages of low molecular weight heparins.

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