Fragmin

Generic Name: dalteparin (DAL te PAR in)
Brand Names: Fragmin

What is Fragmin?

Fragmin (dalteparin) is an anticoagulant (blood thinner) that prevents the formation of blood clots.

Fragmin is used together with aspirin to prevent blood vessel complications in people with certain types of angina (chest pain) or heart attack.

Fragmin is also used to prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery, or in people who are bed-ridden due to a prolonged illness.

Fragmin is also used long-term to treat a type of blood clot called venous thromboembolism (VTE) in people with cancer.

Fragmin may also be used for other purposes not listed in this medication guide.

Important information about Fragmin

You should not use Fragmin if you are allergic to dalteparin, heparin, or pork products, or if you have active bleeding, or a low level of platelets in your blood after testing positive for a certain antibody while using Fragmin. If you need anesthesia for a medical procedure or surgery, tell the doctor ahead of time that you are using Fragmin. You may need to stop using the medicine for a short time.

Fragmin may cause you to bleed more easily, especially if you have: a bleeding disorder, hemorrhagic stroke, an infection in the lining of your heart, uncontrolled high blood pressure, stomach or intestinal bleeding or ulcer, or if you have had recent brain, spine, or eye surgery.

Fragmin can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, a history of spinal surgery or repeated spinal taps, or if you are using other medications to treat or prevent blood clots. Symptoms of this type of blood clot include numbness, tingling, muscle weakness, or loss of movement. Tell any doctor who treats you that you are using Fragmin. Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding or life-threatening blood clots, and it is very important to tell your doctor about all medicines you have recently used.

Blood clots around the brain or spinal cord may occur if you use Fragmin with other drugs that can affect blood clotting, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin, and any other medications to treat or prevent blood clots.

Avoid taking aspirin unless your doctor recommends it as part of your treatment. Aspirin can increase your risk of bleeding. Tell your caregivers at once if you have signs of bleeding such as black or bloody stools, coughing up blood, confusion, feeling like you might pass out, or any bleeding that will not stop.

Before using Fragmin

You should not use Fragmin if you are allergic to dalteparin, heparin, or pork products, or if you have:

• active or uncontrolled bleeding; or

• or a low level of platelets in your blood after testing positive for a certain antibody while using Fragmin.

Fragmin may cause you to bleed more easily, especially if you have:

• a bleeding disorder that is inherited or caused by disease;

• hemorrhagic stroke;

• an infection of the lining of your heart (also called bacterial endocarditis);

• uncontrolled high blood pressure;

• stomach or intestinal bleeding or ulcer; or

• recent brain, spine, or eye surgery.

Fragmin can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if you have:

• a genetic spinal defect;

• a history of spinal surgery or repeated spinal taps; or

• if you are using other medications to treat or prevent blood clots.

If you have any of these other conditions, you may need a Fragmin dose adjustment or special tests:

• eye problems caused by diabetes or high blood pressure;

• severe liver or kidney disease;

• recent stomach bleeding; or

• low levels of platelets in your blood.

FDA pregnancy category B. Fragmin is not expected to harm an unborn baby. However, some forms of this medication contain a preservative that may be harmful to a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment with Fragmin. It is not known whether dalteparin passes into breast milk or if it could harm a nursing baby. Do not use Fragmin without telling your doctor if you are breast-feeding a baby.

See also: Fragmin pregnancy and breastfeeding warnings (in more detail)

How should I use Fragmin?

Fragmin is injected under the skin. You may be shown how to use injections at home. Do not self-inject Fragmin if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

You should be sitting or lying down during the injection. Do not inject Fragmin into a muscle.

Use a different place on your stomach each time you give the Fragmin injection. Your care provider will show you the best places on your body to inject the medication. Do not inject into the same place two times in a row.

Prepare your dose in a syringe only when you are ready to give yourself an injection. Do not use Fragmin injection if it has changed colors or has particles in it. Call your doctor for a new prescription.

Do not mix Fragmin with other medications in the same syringe unless your doctor tells you to.

If you use a single-dose prefilled syringe, follow the injection instructions closely. Single-dose syringes come in two different types and the directions for use are not the same for each type.

Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

When used for DVT or blood vessel complications, Fragmin is usually given every day until your bleeding condition improves. When used for VTE, Fragmin is often used for several months. Follow your doctor's instructions.

To be sure Fragmin is not causing harmful effects, your blood and your stool (bowel movement) may need to be tested often. Your nerve and muscle function may also need to be tested. Visit your doctor regularly.

Tell any doctor who treats you that you are using Fragmin. If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using this medication. If you need anesthesia for a medical procedure or surgery, you may need to stop using Fragmin for a short time.

Store Fragmin vials (bottles) at room temperature away from moisture and heat. Once you have used a vial for the first time, the medicine will keep at room temperature for up to 2 weeks. Throw away the vial after 2 weeks have passed since you first used the vial, even if there is still medicine left in it.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose may cause excessive bleeding.

What should I avoid while using Fragmin?

Avoid taking aspirin unless your doctor recommends it as part of your treatment. Aspirin can increase your risk of bleeding. Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Fragmin side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Fragmin: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Fragmin and call your doctor at once if you have a serious side effect such as:

• unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;

• easy bruising, purple or red pinpoint spots under your skin;

• pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

• black or bloody stools, coughing up blood or vomit that looks like coffee grounds;

• numbness, tingling, or muscle weakness (especially in your legs and feet);

• loss of movement in any part of your body;

• sudden weakness, severe headache, confusion, or problems with speech, vision, or balance; or

• trouble breathing.

Less serious Fragmin side effects include pain, redness, or swelling where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Fragmin side effects (in more detail)

What other drugs will affect Fragmin?

Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding, and it is very important to tell your doctor about all medicines you have recently used. Bleeding or blood clots around the brain or spinal cord may occur if you use Fragmin with other drugs that can affect blood clotting, such as:

• dextran (Gentran, Hyskon);

• heparin, warfarin (Coumadin);

• abciximab (ReoPro), eptifibatide (Integrelin), tirofiban (Aggrastat);

• cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine, Aggrenox), prasugrel (Effient), ticlopidine (Ticlid);

• enoxaparin (Lovenox), fondaparinux (Arixtra), tinzaparin (Innohep);

• argatroban (Acova), bivalirudin (Angiomax), lepirudin (Refludan);

• alteplase (Activase), tenecteplase (TNKase), urokinase (Abbokinase);

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others; or

• salicylates such as Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan's Pills Extra Strength, Pepto-Bismol, Tricosal, and others.

This list is not complete and other drugs may interact with Fragmin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your doctor or pharmacist can provide more information about Fragmin.

• Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

Copyright 1996-2010 Cerner Multum, Inc. Version: 6.01. Revision Date: 05/07/2010 3:27:59 PM.