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.