Home Drug Guide Dalteparin Sodium

Drug Guide

Generic Name

Dalteparin Sodium

Brand Names Fragmin

Classification

Therapeutic: Anticoagulant, Antithrombotic

Pharmacological: Low molecular weight heparin (LMWH)

FDA Approved Indications

  • Deep vein thrombosis (DVT) prophylaxis
  • Treatment of DVT and pulmonary embolism (PE)
  • Reduction of risk of recurrent VTE in patients with symptomatic VTE

Mechanism of Action

Dalteparin enhances the activity of antithrombin III, which inactivates factor Xa and IIa (thrombin), leading to anticoagulation.

Dosage and Administration

Adult: Dosage varies based on indication; typically, subcutaneous administration of 2500-25000 units daily. For DVT prophylaxis, 2500-5000 units once daily or as prescribed.

Pediatric: Limited data; use only if approved by a specialist, with dosing based on weight and clinical circumstances.

Geriatric: Adjust dose cautiously; monitor renal function closely.

Renal Impairment: Reduce dose or extend dosing interval in patients with renal impairment due to accumulation risk.

Hepatic Impairment: No specific adjustment; use with caution and monitor bleeding.

Pharmacokinetics

Absorption: Rapidly absorbed after subcutaneous injection with a bioavailability of approximately 90%.

Distribution: Extensively bound to plasma proteins and low affinity for tissues.

Metabolism: Limited metabolism; primarily cleared by the reticuloendothelial system and renal pathways.

Excretion: Excreted mainly via the kidneys.

Half Life: Approximately 2.4 to 4.8 hours.

Contraindications

  • History of heparin-induced thrombocytopenia (HIT)
  • Active major bleeding
  • Severe thrombocytopenia

Precautions

  • Use caution in patients with bleeding disorders, recent surgery, or ocular surgery.
  • Monitor for signs of bleeding or HIT closely.

Adverse Reactions - Common

  • Bleeding (Common)
  • Injection site reactions (hematoma, pain) (Common)

Adverse Reactions - Serious

  • HIT (heparin-induced thrombocytopenia) (Serious but less common)
  • Spinal/epidural hematoma in patients receiving neuraxial anesthesia (Rare)

Drug-Drug Interactions

  • Other anticoagulants (e.g., warfarin, aspirin, clopidogrel)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of bleeding, platelet counts, renal function.

Diagnoses:

  • Risk for bleeding

Implementation: Administer subcutaneously, rotate injection sites. Avoid intramuscular injections.

Evaluation: Check for any bleeding complications or signs of HIT; monitor laboratory parameters.

Patient/Family Teaching

  • Report any unusual bleeding or bruising immediately.
  • Inform about injection site care.
  • Do not discontinue medication without consulting healthcare provider.

Special Considerations

Black Box Warnings:

  • Spinal/epidural hematoma risk with neuraxial anesthesia or spinal puncture.

Genetic Factors: Limited specific data.

Lab Test Interference: Can affect antifactor Xa assays used to monitor therapy.

Overdose Management

Signs/Symptoms: Excessive bleeding, hemorrhage.

Treatment: Discontinue drug; administer protamine sulfate if severe bleeding occurs, although partial neutralization of dalteparin; supportive care.

Storage and Handling

Storage: Store at room temperature (20-25°C), protect from light.

Stability: Stable for up to 24 months if unopened.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.