fragmin

Fragmin (dalteparin) is an anticoagulant that helps prevent the formation of blood clots.

Fragmin is used together with aspirin to prevent blood vessel complications in people with certain types of angina (chest pain) or heart attack.

Fragmin is also used to prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery, or in people who are bed-ridden due to a prolonged illness.

Fragmin is also used long-term to treat a type of blood clot called venous thromboembolism (VTE) in people with cancer.

Fragmin may also be used for purposes not listed in this medication guide.

Important information

You should not use this medicine if you have active bleeding, or a low level of platelets in your blood after testing positive for a certain antibody while using Fragmin.

Fragmin can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, a history of spinal surgery or repeated spinal taps, or if you are using other drugs that can affect blood clotting, including blood thinners or NSAIDs (ibuprofen, Advil, Aleve, and others). This type of blood clot can lead to long-term or permanent paralysis.

Get emergency medical help if you have symptoms of a spinal cord blood clot such as back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Before taking this medicine

You should not use Fragmin if you are allergic to dalteparin, heparin, or pork products, or if you have:

• active or uncontrolled bleeding; or

• a low level of platelets in your blood after testing positive for a certain antibody while using Fragmin.

Fragmin may cause you to bleed more easily, especially if you have:

• a bleeding disorder that is inherited or caused by disease;

• hemorrhagic stroke;

• an infection of the lining of your heart (also called bacterial endocarditis);

• uncontrolled high blood pressure;

• stomach or intestinal bleeding or ulcer; or

• recent brain, spine, or eye surgery.

Fragmin can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term or permanent paralysis, and may be more likely to occur if:

• you have a genetic spinal defect;

• you have a spinal cord injury;

• you have a spinal catheter in place or if a catheter has been recently removed;

• you have a history of spinal surgery or repeated spinal taps;

• you have recently had a spinal tap or epidural anesthesia;

• you are taking an NSAID (nonsteroidal anti-inflammatory drug)--ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, indomethacin, meloxicam, and others; or

• you are using a blood thinner (warfarin, Coumadin) or other medicines to treat or prevent blood clots.

To make sure Fragmin is safe for you, tell your doctor if you have:

• eye problems caused by diabetes or high blood pressure;

• severe liver or kidney disease;

• recent stomach bleeding;

• low levels of platelets in your blood; or

• if you have recently had a spinal tap or epidural anesthesia.

FDA pregnancy category B. Fragmin is not expected to harm an unborn baby. However, some forms of this medication contain a preservative that may be harmful to a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

See also: Pregnancy and breastfeeding warnings (in more detail)

It is not known whether dalteparin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use Fragmin?

Use Fragmin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

When used for DVT or blood vessel complications, Fragmin is usually given every day until your bleeding condition improves. When used for VTE, Fragmin is often used for several months.

Fragmin is injected under the skin. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Do not mix Fragmin with other medications in the same syringe unless your doctor tells you to.

Prepare your dose in a syringe only when you are ready to give yourself an injection. Do not use a injection vial if it has changed colors or has particles in it. Call your pharmacist for new medication.

You should be sitting or lying down during the injection. Do not inject Fragmin into a muscle.

Use a different place on your stomach each time you give the injection. Your care provider will show you the best places on your body to inject the medication. Do not inject into the same place two times in a row.

If you use a single-dose prefilled syringe, follow the injection instructions closely. Single-dose syringes come in two different types and the directions for use are not the same for each type.

Use a disposable needle only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Tell any doctor who treats you that you are using Fragmin. If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using this medication. If you need anesthesia for a medical procedure or surgery, you may need to stop using Fragmin for a short time.

While using Fragmin, your blood and your stool (bowel movement) may need to be tested often. Your nerve and muscle function may also need to be tested.

Store the medicine vials (bottles) at room temperature away from moisture and heat. Once you have used a vial for the first time, the medicine will keep at room temperature for up to 2 weeks. Throw away the vial after 2 weeks have passed since you first used the vial, even if there is still medicine left in it.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose may cause excessive bleeding.

What should I avoid while using Fragmin?

Avoid taking aspirin unless your doctor recommends it as part of your treatment. Aspirin can increase your risk of bleeding.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Fragmin side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Fragmin: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Also seek emergency medical attention if you have symptoms of a spinal blood clot: back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Stop using Fragmin and call your doctor at once if you have:

• unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;

• easy bruising, purple or red pinpoint spots under your skin;

• pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

• black or bloody stools, coughing up blood or vomit that looks like coffee grounds;

• sudden weakness, severe headache, confusion, or problems with speech, vision, or balance; or

• trouble breathing.

Common Fragmin side effects may include:

• pain, redness, or swelling where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Fragmin?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Fragmin, especially other medicines used to treat or prevent blood clots, such as:

• abciximab, anagrelide, cilostazol, clopidogrel, dipyridamole, eptifibatide, ticlopidine, tirofiban;

• alteplase, reteplase, tenecteplase, urokinase;

• apixaban, argatroban, bivalirudin, dabigatran, desirudin, enoxaparin, fondaparinux, lepirudin, rivaroxaban, tinzaparin; or

• heparin.

This list is not complete. Other drugs may interact with dalteparin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.