Skip to Content

dalteparin

Pronunciation

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

What is dalteparin?

Dalteparin is an anticoagulant that helps prevent the formation of blood clots.

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

Dalteparin 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.

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

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

What is the most important information I should know about dalteparin?

You should not use this medicine if you have active bleeding, or a low level of platelets in your blood after testing positive for a certain antibody while using dalteparin.

Dalteparin can cause a very serious blood clot around your 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 drugs that can affect blood clotting, including blood thinners or NSAIDs (ibuprofen, Advil, Aleve, and others). This type of blood clot can lead to long-term or permanent paralysis.

Slideshow: Seasoned Pro: Be Mindful of These Winter Health Hazards

Get emergency medical help if you have symptoms of a spinal cord blood clot such as back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

What should I discuss with my healthcare provider before using dalteparin?

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

  • active or uncontrolled bleeding; or

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

Dalteparin 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.

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

  • you have a genetic spinal defect;

  • you have a spinal cord injury;

  • you have a spinal catheter in place or if a catheter has been recently removed;

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

  • you have recently had a spinal tap or epidural anesthesia;

  • you are taking an NSAID (nonsteroidal anti-inflammatory drug)--ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, indomethacin, meloxicam, and others; or

  • you are using a blood thinner (warfarin, Coumadin) or other medicines to treat or prevent blood clots.

To make sure dalteparin is safe for you, tell your doctor if you have:

  • eye problems caused by diabetes or high blood pressure;

  • severe liver or kidney disease;

  • recent stomach bleeding;

  • low levels of platelets in your blood; or

  • if you have recently had a spinal tap or epidural anesthesia.

FDA pregnancy category B. Dalteparin 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.

It is not known whether dalteparin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use dalteparin?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

When used for DVT or blood vessel complications, dalteparin is usually given every day until your bleeding condition improves. When used for VTE, dalteparin is often used for several months.

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

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

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

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

Use a different place on your stomach each time you give the 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.

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. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Tell any doctor who treats you that you are using dalteparin. 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 dalteparin for a short time.

While using dalteparin, your blood and your stool (bowel movement) may need to be tested often. Your nerve and muscle function may also need to be tested.

Store dalteparin 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 dalteparin?

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.

Dalteparin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Also seek emergency medical attention if you have symptoms of a spinal blood clot: back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Stop using dalteparin and call your doctor at once if you have:

  • 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;

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

  • trouble breathing.

Common side effects may 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: Side effects (in more detail)

Dalteparin dosing information

Usual Adult Dose for Myocardial Infarction:

120 international units/kg of body weight subcutaneously every 12 hours with concurrent oral aspirin (75 to 165 mg once a day) therapy

Maximum dose: 10,000 international units subcutaneously every 12 hours

Duration of therapy: Continue treatment until clinically stable; usual duration of 5 to 8 days.

Comments:
-Concurrent aspirin therapy is recommended unless contraindicated.
-Volume to be administered by patient weight based on a 9.5 mL vial (10,000 international units/mL): Less than 50 kg: 0.55 mL; 50 to 59 kg: 0.65 mL; 60 to 69 kg: 0.75 mL; 70 to 79 kg: 0.9 mL; 80 kg or greater: 1 mL

Use: Prophylaxis of ischemic complications in unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin therapy.

Usual Adult Dose for Angina Pectoris:

120 international units/kg of body weight subcutaneously every 12 hours with concurrent oral aspirin (75 to 165 mg once a day) therapy

Maximum dose: 10,000 international units subcutaneously every 12 hours

Duration of therapy: Continue treatment until clinically stable; usual duration of 5 to 8 days.

Comments:
-Concurrent aspirin therapy is recommended unless contraindicated.
-Volume to be administered by patient weight based on a 9.5 mL vial (10,000 international units/mL): Less than 50 kg: 0.55 mL; 50 to 59 kg: 0.65 mL; 60 to 69 kg: 0.75 mL; 70 to 79 kg: 0.9 mL; 80 kg or greater: 1 mL

Use: Prophylaxis of ischemic complications in unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin therapy.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery:

Preoperative start (evening before surgery):
-5000 international units subcutaneously 10 to 14 hours before surgery; allow approximately 24 hours between doses
-5000 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved
-5000 international units subcutaneously during postoperative period

Preoperative start (day of surgery):
-2500 international units subcutaneously within 2 hours before surgery
-2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved; allow a minimum of 6 hours between this dose and the dose to be given on postoperative day 1
-5000 international units subcutaneously during postoperative period

Postoperative start:
-2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved; allow a minimum of 6 hours between this dose and the dose to be given on postoperative day 1
-5000 international units subcutaneously during postoperative period

Duration of therapy: Usually 5 to 10 days after surgery; up to 14 days has been well tolerated.

Use: Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing hip replacement surgery.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Abdominal Surgery:

Moderate risk of thromboembolic complications: 2500 international units subcutaneously once a day, starting 1 to 2 hours prior to surgery and repeated once a day postoperatively.

High risk of thromboembolic complications (e.g., malignant disorder): 5000 international units subcutaneously the evening before surgery and once a day postoperatively OR 2500 international units subcutaneously 1 to 2 hours before surgery followed 2500 international units subcutaneously 12 hours later and then 5000 international units subcutaneously once a day postoperatively.

Duration of therapy: Usually 5 to 10 days

Use: Prophylaxis of DVT, which may lead to PE in patients undergoing abdominal surgery who are at risk for thromboembolic complications.

Usual Adult Dose for Deep Vein Thrombosis -- Prophylaxis:

5000 international units subcutaneously once a day

Duration of therapy: Usually 12 to 14 days

Use: Prophylaxis of DVT, which may lead to PE in medical patients who are at risk for thromboembolic complications due to severely restricted mobility during acute illness.

Usual Adult Dose for Venous Thromboembolism:

200 international units/kg total body weight subcutaneously once a day for the first month; 150 international units/kg total body weight subcutaneously once a day for months 2 through 6

Maximum dose: 18,000 international units/day

Duration of therapy: 6 months

Comments:
-In patients with CrCl less than 30 mL/min, monitor anti-Xa levels to determine dose (target anti-Xa range is 0.5 to 1.5 international units/mL); sample 4 to 6 hours after dosing and only after the patient has received 3 to 4 doses.
-Dose to be administered by patient weight during first month: 56 kg or less: 10,000 international units; 57 to 68 kg: 12,500 international units; 69 to 82 kg: 15,000 international units; 83 kg or greater: 18,000 international units.
-Dose to be administered by patient weight during months 2 through 6: 56 kg or less: 7500 international units; 57 to 68 kg: 10,000 international units; 69 to 82 kg: 12,500 international units; 83 to 98 kg: 15,000; 99 kg or greater: 18,000 international units.
-Safety and efficacy beyond 6 months have not been evaluated in cancer patients with acute symptomatic venous thromboembolism (VTE).

Use: Extended treatment of symptomatic VTE (proximal deep vein thrombosis and/or pulmonary embolism), to reduce the recurrence of VTE in patients with cancer.

What other drugs will affect dalteparin?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with dalteparin, especially other medicines used to treat or prevent blood clots, such as:

  • abciximab, anagrelide, cilostazol, clopidogrel, dipyridamole, eptifibatide, ticlopidine, tirofiban;

  • alteplase, reteplase, tenecteplase, urokinase;

  • apixaban, argatroban, bivalirudin, dabigatran, desirudin, enoxaparin, fondaparinux, lepirudin, rivaroxaban, tinzaparin; or

  • heparin.

This list is not complete. Other drugs may interact with dalteparin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about dalteparin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. 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. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 6.06. Revision Date: 2014-04-13, 8:01:01 PM.

(web2)