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FRAGMN 5 000 IU/0.2ML SOLUTION FOR INJECTION

Active substance(s): DALTEPARIN SODIUM

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S0153-RM-PIL-23.07.2014

PACKAGE LEAFLET: INFORMATION FOR THE USER

Fragmin® 5,000 IU/0.2ml Solution for Injection
(dalteparin sodium)
This medicine is also available in other strengths.

Please note that if you are being treated with Fragmin for unstable coronary artery disease your doctor
may adjust your dose of aspirin accordingly.

Read all of this leaflet carefully before you start using this medicine because it contains important
information for you.
 Keep this leaflet. You may need to read it again.
 If you have any further questions, ask your doctor, pharmacist or nurse.
 This medicine has been prescribed for you only. If your doctor has given you this medicine to use at
home do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
 If you get any side effects talk to your doctor, nurse or pharmacist. This includes any possible side
effects not listed in this leaflet. See section 4.
 The product will be referred to as Fragmin throughout this leaflet.

Please tell your doctor or pharmacist if you are taking or have recently taken any other low molecular
weight heparins or anti-thrombotics.

Pregnancy and breast-feeding
Fragmin has not been found to cause harmful effects during pregnancy. The possibility of harm to the
baby appears remote. Tell your doctor if you are pregnant and they will advise you.
Fragmin is not recommended for the prevention of blood clots on artificial heart valves during pregnancy.
If you are receiving Fragmin to treat blood clots, you should not have a local, spinal or epidural
anaesthetic.

What is in this leaflet:
1. What Fragmin is and what it is used for
2. What you need to know before you are given or use Fragmin
3. How Fragmin is given to you
4. Possible side effects
5. How to store Fragmin
6. Contents of the pack and other information

Ask your doctor or pharmacist for advice before being given or using this medicine whilst breast-feeding.

Driving and using machines
Fragmin does not affect the ability to drive and operate machinery.

1. What Fragmin is and what it is used for............................................................
Fragmin is a solution for injection. Its active ingredient is dalteparin sodium.
Fragmin belongs to a group of medicines called low molecular weight heparins or antithrombotics, which
help prevent the formation of blood clots by thinning the blood.
Venous thromboembolism is a condition where blood clots develop in the legs (deep vein thrombosis) or
the lungs (pulmonary embolism), e.g. after surgery, prolonged bed rest or in patients with certain types of
cancer.
 Fragmin is used to prevent blood clots (venous thromboembolism) forming before and after an

operation or if you are bedridden due to illness and to prevent their recurrence.
The 5000 IU product can also be used for:
 Prevention of deep vein thrombosis in patients bedridden due to a medical condition but not limited to,
for example heart failure and respiratory failure.
 Treatment of patients with solid tumours who suffer from low platelet counts.
Ask your doctor if you are unsure why you have been given Fragmin.

2. What you need to know before you are given or use Fragmin
You should not be given Fragmin:

Other medicines that may interfere with Fragmin include:
 Those used to treat angina (intravenous nitroglycerine)
 Antibiotics such as high dose penicillin which are used to treat bacterial infections.
 Anti-malarials (e.g. quinine)
 Tobacco smoking

...................

 if you are allergic (hypersensitive) to the active ingredient dalteparin sodium or a similar product or any

of the other ingredients of this medicine (listed in section 6).
if you have an active stomach ulcer or ulcer of the duodenum (small intestine).
if you have suffered from a brain haemorrhage (bleeding in your brain).
if you have fluid mixed with blood that appears around heart and lungs.
if you suffer from any condition which may cause you to bleed more easily (e.g. haemophilia, liver
failure). Ask your doctor if you are unsure.
 if you have a condition called septic endocarditis (an infection and inflammation of the lining of the
heart and heart valves). Your doctor will have told you if you have this.
 if you have had a condition called “heparin-induced thrombocytopenia” (a decrease in the number of
clotting cells (platelets) in your blood caused by heparin, which may cause you to bruise and bleed
more easily). Your doctor will have told you if you have this.
 if you have an injury to, or have had an operation involving your spine, head, eyes or ears.





If you are receiving Fragmin to treat blood clots, you should not have a local, spinal or epidural
anaesthetic.
If you are given this medicine as part of your cancer treatment your doctor will check that you weigh more
than 40 kg, and that you have not had a stroke within the last 3 months.

Warnings and precautions
Talk to your doctor, pharmacist or nurse before you are given or use Fragmin:
 if you have conditions which make you more susceptible to bleeding e.g:

after an operation or trauma

a stroke caused by a bleed

a brain tumour

severe liver or kidney failure

abnormal or low numbers of platelets (clotting cells)

eye disease caused by blood pressure or diabetes

taking other medicines that thin the blood (e.g. aspirin, warfarin, dipyridamole)

uncontrolled high blood pressure.
 if you have been told by your doctor that you have a lot of potassium in your blood or have a low blood

pH. Your doctor will monitor your blood regularly before and during treatment.
 if you have ever had an operation to insert an artificial heart valve.
 if you need to have any other injections.

You may need to have blood tests to monitor the effects of Fragmin:

if you have kidney failure or liver problems

if you are very thin or morbidly obese

if you are pregnant

if you are at increased risk of bleeding or rethrombosis (more blood clots)

if you are a child

if you have blood problems due to cancer treatment.

3. How Fragmin is given to you..............................................................................
Your medicine will usually be administered by a doctor or nurse or you may be shown how to give the
injection yourself at home (See Section on How to Inject Fragmin). The amount of Fragmin you receive
will depend on your body weight.
Fragmin is given as a single, once daily, subcutaneous injection, which means it is injected beneath the
skin. It is usually injected into a skin fold in your abdomen (stomach), or the outer aspects of your thigh. It
should not be injected into your muscles.

Use in adults and the elderly
To prevent blood clots (venous thromboprophylaxis)
 Patients with a moderate risk of developing a clot:
The recommended dose is 2,500 IU one to two hours before the operation, then 2,500 IU each morning.
This is continued for five to seven days, or until you are fully able to move about.
 Patients with a greater risk of developing a clot e.g. those who have had clots in the past:
For this type of patient, the recommended dose is 2,500 IU one to two hours before the operation, the
same dose 8 to 12 hours later, then 5,000 IU each morning. As an alternative, 5,000 IU may be given the
evening before the operation, then 5,000 IU on following evenings. The first dose (2500 IU) may also be
given as soon as possible after your operation and is to be continued for five to seven days, or until you
are able to move about.



Hip Replacement Surgery
After a hip operation, your doctor may decide to continue treating you with Fragmin for five weeks using a
dose of 5,000 IU every evening. If you have an artificial heart valve, the normal dose for prevention of
blood clots is not sufficient. Your doctor will discuss this with you.
 The maximum dose you will be given in a 12 hour period is 10,000 IU.
 If you are bedridden due to illness, the dose of Fragmin given will be 5,000 IU daily. The length of
treatment will be up to 14 days, depending on your illness.
These are typical doses for adults, including elderly patients. Your doctor will work out the right dose for
you. Some of the liquid in the syringe may have to be expelled before the injection is given.
To treat blood clots (venous thromboembolism) in certain types of cancer and prevent recurrence
The usual dose used to treat venous thromboembolism in cancer is 200 IU (international units) for every
kilogram you weigh (see table below) once daily during the first month after a thromboembolic event
(blood clot), followed by 150 IU for every kilogram you weigh (during months 2-6).

Dose of Fragmin during month 1
Body Weight (kg)
<46
46-56
57-68
69-82
≥83

Dose (IU)
7,500
10,000
12,500
15,000
18,000

Dose of Fragmin during months 2-6
Body Weight (kg)
≤56
57 to 68
69 to 82
83 to 98
≥99

Dose (IU)
7,500
10,000
12,500
15,000
18,000

This treatment course is not recommended for patients weighing less than 40 kg.
The maximum daily dose is 18,000 IU. The recommended duration of treatment is 6 months. If you are
suffering from severe kidney disease or a decreased platelet count (clotting cells) caused by
chemotherapy or another condition with an elevated bleeding risk, your doctor will adjust this dose
accordingly.

Children and adolescents

In some cases of decreased platelet count (clotting cells), your doctor may interrupt your treatment with
Fragmin for a short period.

Dosing recommendations in children are based on clinical experience; there are limited data from clinical
trials, which will help your doctor calculate the dose of Fragmin.

Medical staff may take blood samples during your treatment to monitor the effects of Fragmin.

Other medicines and Fragmin

How to Inject Fragmin

Tell your doctor, pharmacist or nurse if you are taking, have recently taken or are planning to take or use
any other medicines. This includes medicines that you have bought for yourself.

This section of the leaflet explains how you should go about injecting Fragmin yourself, but you should
only do so if you have been given permission by your doctor. It is a simple process and one that you can
do at home.

Some medicines can affect the way Fragmin works, or Fragmin itself can reduce the effectiveness of
other medicines taken at the same time.
Medicines that increase the effect of Fragmin include:
 Those used to thin your blood (e.g. aspirin, dipyridamole, glycoprotein receptor antagonists and
warfarin).
 Medicines called non-steroidal anti-inflammatory drugs (NSAIDs) used to reduce pain and inflammation
(e.g. indometacin).
 Some medicines for gout (e.g. sulfinpyrazone and probenecid).
 Etacrynic acid (a water retention tablet (diuretic)).
 Solutions given to increase the blood volume (e.g. dextrans).
 Medicines known as cytostatics (used in cancer treatment).
 Thrombolytic medications for treating transmural heart attack (e.g. TPA-tissue plasminogen activator).
Medicines that can reduce the effect of Fragmin include:
 Those for allergy and hay fever (e.g. antihistamines).
 Those used for heart or circulation problems (e.g. digoxin or digitoxin).
 Antibiotics known as tetracyclines which are used to treat bacterial infections.
 Vitamin C (e.g. some vitamin supplements).

Fragmin is given by a small injection under the skin. You should inject (or give) the dose of Fragmin at the
time recommended by your doctor. Please follow the steps explained below.
 Gather the single dose Fragmin syringe and the yellow sharps bin.
 Wash and dry your hands. The injection site should be cleaned.
Please note that if a carer is doing the injecting, it is recommended that they wear gloves to perform the
injection.

Step 1:
Get yourself in a comfortable sitting down position where you can see
your stomach.

Do not store above 25°C.
Your doctor or nurse will store Fragmin in a safe place under the above conditions.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to
dispose of medicines no longer required. These measures will help to protect the environment.

Step 2:
Choose an injection site either on your stomach or outer aspects of your left
or right thigh (see shaded areas). Your stomach is usually best as the
injection site and it is important that you change the site each time.

6. Contents of the pack and other information....................................................
What Fragmin contains
The active ingredient in Fragmin is dalteparin sodium. Each syringe contains 5,000 IU (International units)
of dalteparin sodium in 0.2 ml of solution.
The other ingredients are: sodium hydroxide, hydrochloric acid and water for injections.

What Fragmin looks like and contents of the pack
Fragmin is available as a clear, colourless solution in pre-filled, glass, single dose syringes with grey
rubber stopper, each containing 0.2ml of dalteparin sodium solution.
10 syringes are packed in each box.

Step 3:
Pick up the syringe and remove the grey rubber cover by pulling it straight off. You will notice an air
bubble in the syringe. It is supposed to be there and you can just ignore it. It is important not to press the
plunger just yet as some of the medicine may be lost.

Manufactured by: Pfizer Manufacturing Belgium NV, Rijksweg 12, B-2870 Puurs, Belgium

Step 4:

Product Licence Holder: Sam Pharma Ltd, Unit 20 Garrick Industrial Estate, Irving Way, Hendon,
London, NW9 6AQ.

Hold the syringe in one hand and with the other hand, gently pinch a fold of skin with its fatty tissue (see
the shaded areas above) between your thumb and index finger. This will be the injection site.

Procured from within the EU and repackaged by: Amimed Direct Ltd, Hendon, London, NW9 6AQ

POM

PL 33902/0153

Step 5:
Hold the syringe above the folded skin keeping it at a right angle (ie
vertically as in the diagram and not at an angle). Insert the needle into
the skin until the needle is fully inserted.

Now press the plunger and inject the Fragmin slowly until all of the medicine has been injected. Keep
pinching the fold of skin while you are injecting and then release the fold of skin and pull the needle out.
If there is any oozing of blood at the injection site, apply gentle pressure. Do not rub the injection site as
this may encourage bruising.
Dispose of the syringe in the yellow sharps bin provided. Keep your sharps bin out of reach of other
people. When the sharps bin is almost full please speak to your doctor or nurse.

Children and adolescents
The dose will be based on both the child’s age and weight. Younger children may need slightly more
Fragmin per kg than adults. Your doctor will work out the right dose for you.
Medical staff may take blood samples during your treatment to monitor the effects of Fragmin.

If you are given more Fragmin than you should
If you feel that you have been given more Fragmin than you should, inform your doctor or nursing staff
immediately. Your doctor may initiate measures to decrease the risk of bleeding.

If you forget to use Fragmin
Tell your doctor or pharmacist if you think that a dose has been forgotten.
A double dose should not be given to make up for a forgotten dose.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

4. Possible side effects.........................................................................................
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Stop using Fragmin and talk to a doctor or nurse at once if you get any signs of a severe allergic reaction
(such as difficulty breathing, swelling of the lips, mouth, throat or eyes).
Common side effects (may affect up to 1 in 10 people):

 A reversible decrease in the number of clotting cells (platelets) in your blood (Type I

thrombocytopenia). This may make you bruise more easily.
Bleeding at any site
Certain substances produced by your liver may increase
Pain and reactions at the injection site
Haematoma – you may notice blood collecting under the skin






-

Uncommon side effects (may affect up to 1 in 100 people):

 Increased levels of potassium in your blood (symptoms may include temporary muscle weakness, loss

of feeling and changes in your heartbeat)
 Red skin rash and itchiness
 Itching
 Allergic reactions

-

Rare side effects (may affect up to 1 in 1,000 people):

 An immune system problem resulting in a severe decrease in the number of clotting cells (platelets) in

your blood (Type II thrombocytopenia)
 Alopecia (hair loss)
 Painful skin lesions

-

Not known (frequency cannot be estimated from the available data):

 Bleeding inside or around your brain, symptoms may include sudden severe headache
 Bleeding behind your abdomen (stomach), symptoms may include a feeling of tenderness and swelling

around your stomach.
 Bruising of the spine which may lead to back pain, tingling, numbness or weakness in your legs, bowel

or bladder problems
If you have an artificial heart valve, treatment with Fragmin might not be sufficient to prevent a blood clot,
and you might develop a clot in the heart valve.
The adverse reactions in children are expected to be the same as in adults, however there is only a little
information about the possible side effects of long term use in children.
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible
side effects not listed in this leaflet.

Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme
at: www.mhra.gov.uk/yellowcard.
By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Fragmin

....................................................................................

Keep out of the sight and reach of children.
Fragmin should not be used after the expiry date which is stamped on the pack. The expiry date refers to
the last day of that month.
Store in original package.

Fragmin® is a registered trademark of Pfizer Ltd.

S0153-RM-PIL-23.07.2014

Step 6:

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Leaflet revision date: 23/07/2014

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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