page162
increased risk of bleeding (e.g. in renal impairment and
those who are underweight or overweight).
Haemorrhage
See under Heparin.
Pregnancy
See under Heparin.
BEMIPARIN SODIUM
Indications
see notes above and under preparations
Cautions
see under Heparin and notes above
Contra-indications
see under Heparin
Hepatic impairment
manufacturer advises use with
caution and avoid in severe impairment
Renal impairment
risk of bleeding may be
increased—use with caution; monitoring of anti-Fac-
tor Xa may be required; use of unfractionated heparin
may be preferable
Pregnancy
manufacturer advises avoid unless essen-
tial—no information available;
see also Pregnancy,
p.
140
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
see under Heparin
Dose
. See under preparations below
Zibor
c
(Archimedes) T A
Injection
,
bemiparin sodium 12 500 units/mL,
net
price 2500-unit (0.2-mL) prefilled syringe = £1.86;
17 500 units/mL,
3500-unit (0.2-mL) prefilled syringe
= £2.75
Dose
prophylaxis of deep-vein thrombosis,
by subcutaneous
injection
, moderate risk, 2500 units 2 hours before or 6 hours after
surgery then 2500 units every 24 hours;
high risk,
3500 units 2
hours before or 6 hours after surgery then 3500 units every 24
hours
Prevention of clotting in extracorporeal circuits,
consult product
literature
Injection
,
bemiparin sodium 25 000 units/mL,
net
price 0.2-mL (5000-unit) prefilled syringe = £4.22, 0.3-
mL (7500-unit) prefilled syringe = £5.34,
0.4-mL
(10 000-unit) prefilled syringe = £4.39
Dose
treatment of deep-vein thrombosis (with or without
pulmonary embolism),
by subcutaneous injection,
115 units/kg
every 24 hours until adequate oral
anticoagulation established
DALTEPARIN SODIUM
Indications
see notes above and under preparations
Cautions
see under Heparin and notes above
Contra-indications
see under Heparin
Hepatic impairment
dose reduction may be required
in severe impairment
Renal impairment
risk of bleeding may be
increased—dose reduction,
and monitoring of anti-
Factor Xa, may be required;
use of unfractionated
heparin may be preferable
Pregnancy
not known to be harmful; multidose vial
contains benzyl alcohol—manufacturer advises avoid;
see also Pregnancy,
p.
140
Breast-feeding
no information available
Side-effects
see under Heparin
Dose
. See under preparations below
Fragmin
c
(Pharmacia) T A
Injection
(single-dose syringe),
dalteparin sodium
12 500 units/mL, net price 2500-unit (0.2-mL) syringe
= £1.86;
25 000 units/mL,
5000-unit (0.2-mL) syringe
= £2.82,
7500-unit (0.3-mL) syringe = £4.23,
10 000-
unit (0.4-mL) syringe = £5.65,
12 500-unit (0.5-mL)
syringe = £7.06, 15 000-unit (0.6-mL) syringe = £8.47,
18 000-unit (0.72-mL) syringe = £10.16
Dose
prophylaxis of deep-vein thrombosis,
in surgical patients,
by subcutaneous injection,
moderate risk,
2500 units 1–2 hours
before surgery then 2500 units every 24 hours;
high risk,
2500 units 1–2 hours before surgery,
then 2500 units 8–12 hours
later (
or
5000 units on the evening before surgery, then 5000 units
on the following evening),
then 5000 units every 24 hours
Prophylaxis of deep-vein thrombosis in medical patients,
by
subcutaneous injection
,
5000 units every 24 hours
Treatment of deep-vein thrombosis and of pulmonary embolism,
by subcutaneous injection,
as a single daily dose,
ADULT body-
weight under 46 kg, 7500 units daily;
body-weight 46–56 kg,
10 000 units daily; body-weight 57–68 kg, 12 500 units daily; body-
weight 69–82 kg, 15 000 units daily;
body-weight 83 kg and over,
18 000 units daily,
with oral
anticoagulant treatment until ade-
quate oral
anticoagulation established;
monitoring of anti-Factor
Xa not usually required;
for patients at increased risk of
haemorrhage, see below
Treatment of venous thromboembolism in pregnancy [unlicensed
indication],
by subcutaneous injection,
early pregnancy body-
weight under 50 kg, 5000 units twice daily; body-weight 50–70 kg,
6000 units twice daily; body-weight 70–90 kg, 8000 units twice
daily;
body-weight over 90 kg, 10 000 units twice daily
Extended treatment and prophylaxis of venous thromboembolism
in patients with solid tumours,
by subcutaneous injection,
once
daily for 30 days,
ADULT body-weight 40–45 kg, 7500 units daily;
body-weight 46–56 kg, 10 000 units daily;
body-weight 57–68 kg,
12 500 units daily; body-weight 69–82 kg, 15 000 units daily; body-
weight 83 kg and over,
18 000 units daily;
then
once daily for a
further 5 months,
by subcutaneous injection, ADULT body-weight
40–56 kg, 7500 units daily;
body-weight 57–68 kg, 10 000 units
daily;
body-weight 69–82 kg, 12 500 units daily;
body-weight 83–
98 kg, 15 000 units daily; body-weight 99 kg and over, 18 000 units
daily;
interrupt treatment or reduce dose in chemotherapy-
induced thrombocytopenia—consult product literature
Injection
,
dalteparin sodium 2500 units/mL (for sub-
cutaneous or intravenous use),
net price 4-mL
(10 000-unit) amp = £5.12;
10 000-units/mL (for sub-
cutaneous or intravenous use),
1-mL (10 000-unit)
amp = £5.12;
25 000 units/mL (for subcutaneous use
only), 4-mL (100 000-unit) vial = £48.66
Excipients
include benzyl alcohol (in 100 000-unit/4 mL multidose vial)
(avoid in neonates,
see Excipients,
p.
2)
Dose
treatment of deep-vein thrombosis and of pulmonary
embolism,
by subcutaneous injection,
200 units/kg (max.
18 000 units) as a single daily dose (
or
100 units/kg twice daily if
increased risk of haemorrhage) until adequate oral
anti-
coagulation established
Note
For monitoring, blood should be taken 3–4 hours after a dose
(recommended plasma concentration of anti-Factor Xa 0.5–
1 unit/mL);
monitoring not required for once-daily treatment
regimen and not generally necessary for twice-daily regimen
Unstable coronary artery disease,
by subcutaneous injection,
120 units/kg every 12 hours (max. 10 000 units twice daily) for 5–
8 days
Prevention of clotting in extracorporeal circuits,
consult product
literature
Injection
(graduated syringe),
dalteparin sodium
10 000 units/mL, net price 1-mL (10 000-unit) syringe
= £5.65
Dose
unstable coronary artery disease (including non-ST-seg-
ment-elevation myocardial infarction),
by subcutaneous injec-
tion,
120 units/kg every 12 hours (max.
10 000 units twice daily)
for up to 8 days;
beyond 8 days (if awaiting angiography or
revascularisation) women body-weight less than 80 kg and men
less than 70 kg, 5000 units every 12 hours, women body-weight
greater than 80 kg and men greater than 70 kg, 7500 units every
12 hours, until
day of procedure (max.
45 days)
ENOXAPARIN SODIUM
Indications
see notes above and under preparations
Cautions
see under Heparin and notes above;
low
body-weight (increased risk of bleeding)
Contra-indications
see under Heparin
142
2.8.1 Parenteral anticoagulants
BNF 61
2
Cardiovascular system