Applies to the following strengths: 20,000 anti-Factor Xa intl units/mL
Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Deep Vein Thrombosis
175 anti-Xa intl units/kg subcutaneously once daily for at least 6 days and until the patient is adequately anticoagulated with warfarin.
Renal Dose Adjustments
No specific renal dosing data are available; however, tinzaparin clearance is reduced in patients with renal dysfunction. Caution is advised when using tinzaparin in patients with severe renal dysfunction.
Liver Dose Adjustments
No data are available; however, the hepatic route is not a major route of elimination of low molecular weight heparins, so the need for dosing adjustments appears to be unlikely.
No dose adjustment appears to be necessary in a majority of pregnant women as tinzaparin requirements (i.e., anti-Xa activity) do not appear to change as gestation progresses. The authors of a study involving 54 pregnant patients recommended 175 anti-Xa units/kg once daily and 75 anti-Xa units/kg once daily in pregnant women at high and moderate thrombotic risk, respectively.
The pharmacokinetics of tinzaparin are not affected by bodyweight or body mass index when administered at 75 or 175 anti-Xa units/kg.
No dosage adjustment is recommended based on age or gender. In pharmacokinetic studies, the clearance of tinzaparin was not affected by age nor gender.
When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is used, patients who are anticoagulated or scheduled for anticoagulation with low molecular weight heparins or heparinoids are at risk for the development of epidural or spinal hematomas which can result in long-term or permanent paralysis. The risk of these events is increased by use of indwelling epidural catheters for administration of analgesia or the concomitant use of drugs affecting hemostasis such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants. The risk appears increased by traumatic or repeated epidural or spinal puncture. Frequent monitoring of these patients is recommended for signs and symptoms of neurological impairment. If neurological impairment is noted, urgent treatment is indicated. Potential benefit versus risk is to be considered in patients who are anticoagulated for thromboprophylaxis.
Tinzaparin is contraindicated in patients with active major bleeding, patients with heparin-induced thrombocytopenia, and patients with hypersensitivity to sulfites, benzyl alcohol, and/or pork products.
Use with caution in patients at an increased risk of bleeding and therapy should be discontinued in the event of severe hemorrhage.
Thrombocytopenia has occurred during therapy with tinzaparin and discontinuation of therapy is recommended if the platelet count falls below 100,000/mm3.
Tinzaparin is intended for subcutaneous administration. It should not be administered by intramuscular or intravenous injection.
Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).
Data not available
Since tinzaparin may theoretically affect PT/INR results, PT/INR levels should be drawn immediately preceding the next scheduled dose of tinzaparin for patients receiving tinzaparin and warfarin.
Accurate tinzaparin dosing requires the use of appropriately calibrated syringes.
Tinzaparin is administered by deep subcutaneous injection while the patient is lying down or sitting. The injection site should be varied daily between the left and right anterolateral and left and right posterolateral abdominal wall. In order to minimize bruising the injection site should not be rubbed following completion of the injection.
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