Home Drug Guide Fondaparinux Sodium

Drug Guide

Generic Name

Fondaparinux Sodium

Brand Names Arixtra

Classification

Therapeutic: Anticoagulant, Hematologic

Pharmacological: Factor Xa inhibitor

FDA Approved Indications

  • Deep vein thrombosis (DVT) prophylaxis following surgery
  • Pulmonary embolism (PE) treatment

Mechanism of Action

Fondaparinux selectively inhibits activated factor Xa through antithrombin III, leading to decreased thrombin generation and preventing clot formation.

Dosage and Administration

Adult: Prophylaxis of DVT/PE: 2.5 mg subcutaneously once daily; Treatment of PE or DVT: 5 mg, 7.5 mg, or 10 mg subcutaneously once daily, depending on body weight and clinical scenario.

Pediatric: Not approved for pediatric use.

Geriatric: Adjust dose based on renal function; monitor renal function regularly.

Renal Impairment: Reduce dose or avoid in severe renal impairment (CrCl <30 mL/min).

Hepatic Impairment: No specific adjustment recommended.

Pharmacokinetics

Absorption: Rapid, complete absorption after subcutaneous injection.

Distribution: Volume of distribution approximately 7-11 liters.

Metabolism: Minimal metabolism; primarily eliminated unchanged by kidneys.

Excretion: Renal excretion (main route).

Half Life: Approximately 17-21 hours.

Contraindications

  • Hypersensitivity to fondaparinux or any component.
  • Active major bleeding.
  • Severe renal impairment (CrCl <30 mL/min).

Precautions

  • Use with caution in patients with renal impairment, bleeding disorders, or recent surgery. Monitor renal function and signs of bleeding.

Adverse Reactions - Common

  • Bleeding (Common)
  • Injection site reactions (pain, erythema) (Less common)

Adverse Reactions - Serious

  • Spontaneous bleeding (Rare)
  • Thrombocytopenia (HIT) (Rare)

Drug-Drug Interactions

  • Other anticoagulants, antiplatelet agents, NSAIDs increasing bleeding risk.

Drug-Food Interactions

  • No significant food interactions reported.

Drug-Herb Interactions

  • Potential additive bleeding risk with herbs affecting coagulation (e.g., ginkgo, garlic).

Nursing Implications

Assessment: Monitor signs of bleeding, check renal function before and during therapy, assess injection sites.

Diagnoses:

  • Risk for bleeding
  • Impaired tissue integrity related to hemorrhage.

Implementation: Administer subcutaneously as prescribed, ensure proper injection technique, monitor laboratory and clinical signs regularly.

Evaluation: Assess for signs of bleeding, monitor laboratory values (hemoglobin, hematocrit, platelet count).

Patient/Family Teaching

  • Report any unusual bleeding, bruising, or pain.
  • Use injectable medication as directed, do not aspirate or massage injection sites.
  • Avoid activities that increase bleeding risk.
  • Keep appointments for monitoring renal function.

Special Considerations

Black Box Warnings:

  • Spinal/epidural hematomas risk with neuraxial anesthesia or lumbar puncture leading to paralysis.

Genetic Factors: None specific.

Lab Test Interference: Can cause false elevations in some assays of coagulation.

Overdose Management

Signs/Symptoms: Excessive bleeding, hemorrhage.

Treatment: Discontinue drug, apply pressure to bleeding sites, consider administration of andexanet alfa or recombinant activated factor VII in severe cases, supportive measures.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F), protected from moisture.

Stability: Stable until the expiration date on the packaging.

🛡️ 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.