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Fragmin

dalteparin
Used for Heart Attack, Deep Vein Thrombosis, Pulmonary Embolism, Angina
Used for Heart Attack, Deep Vein Thrombosis, Pulmonary Embolism, Angina

Fragmin (dalteparin) is an injectable medication used to treat and prevent blood clots. It needs to be injected every day and comes in prefilled syringes for convenient home injections.

Reviewed by:
reviewer
Hope Chang, PharmD, AAHIVP
reviewer
Allison Gourley, PharmD
Last reviewed on August 3, 2021
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostAlternativesPricesMedicare
basics-icon

What is Fragmin (dalteparin)?

What is Fragmin (dalteparin) used for?

  • Blood clot prevention after abdominal surgery, after hip or knee replacement surgery, or when you are very sick and bedridden

  • Prevention of complications in people with unstable angina or NSTEMI (a type of heart attack)

  • Extended treatment of symptomatic blood clots to prevent future blood clots in people with cancer

  • Treatment of symptomatic blood cots in children age 1 month or older

How Fragmin (dalteparin) works

Fragmin (dalteparin) is an anticoagulant, which are often called blood thinners. As a low molecular weight heparin (LMWH), it prevents blood clots by blocking the activity of certain blood-clotting proteins.

Drug Facts

Common BrandsFragmin
Drug ClassAnticoagulant
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Fragmin (dalteparin)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Any bleeding (14%)
  • Major bleeding (6%)

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious bleeding (hematoma) around the spinal cord after an epidural or spinal tap, which can cause paralysis (can't move or feel anything)
  • Low platelets

Source: FDA

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Bruise

deep, dark purple bruise, pain, or swelling at the injection site

nosebleed

Less common

Bleeding of the gums

constipation

coughing up blood

difficulty with breathing or swallowing

dizziness

headache

increased menstrual flow or vaginal bleeding

paralysis

prolonged bleeding from cuts

red or black, tarry stools

red or dark brown urine

severe stomach pain

unexplained pain, swelling, or discomfort, especially in the chest, abdomen or stomach, joints, or muscles

unusual bleeding or bruising

vomiting of blood or material that looks like coffee grounds

weakness

Rare

Back pain

bleeding from mucous membranes

bluish or black discoloration, flushing, or redness of the skin

burning, pricking, tickling, or tingling sensation

cough

feeling faint

fever

leg weakness

numbness

problems with bowel or bladder function

skin rash (which may consist of pinpoint, purple-red spots), hives, or itching

sloughing of the skin at the injection site

swelling of the eyelids, face, or lips

tightness in the chest

Incidence not known

Blue-green to black skin discoloration

decrease in height

pain in the ribs, arms, or legs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

Hair loss or thinning of hair

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Fragmin (dalteparin)

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Pros

Approved for extended (6 month) treatment of blood clots in people with cancer

Can be used in children age 1 month or older

Doesn’t usually need to be monitored with blood tests

In cases of overdose or dangerous bleeding, there is an antidote called protamine that can reverse the effects of Fragmin (dalteparin).

Doesn't interact with food like warfarin (Coumadin) does

thumbs-down

Cons

It's a low-molecular weight heparin, which means you can’t use it if you’ve had heparin-induced thrombocytopenia (HIT).

Brand name only, and can be more expensive than similar medications like enoxaparin (Lovenox)

Not a first-choice medication for people with kidney problems

Can interact with NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), and raise bleeding risk

Some people will need to inject the medication multiple times a day

pharmacist-tips

Pharmacist tips for Fragmin (dalteparin)

pharmacist

  • Talk to your provider or pharmacist to make sure you understand how to inject this medication the correct way before you start it at home. It's important that you get the right amount of medication.

    • People with latex allergies should avoid touching the prefilled Fragmin (dalteparin) syringe. The needle shield may contain rubber latex.

      • Check the solution in the syringe to make sure it hasn't changed colors and doesn't have particles in it. For the fixed-dose syringe, air bubbles are okay, don't push them out before using the syringe or you might lose some medication.

        • Store the syringes at room temperature. If you're using the vial, you can store it at room temperature for up to 2 weeks.

          • The medication must be injected into your fatty tissue and not your muscle. You can inject it into your lower abdomen around your belly button, the upper outter side of your thigh, or certain parts of your butt. Rotate your injeciton site every day to avoid unwanted side effects.

            • Make sure all your providers know you are taking Fragmin (dalteparin), especially surgeons and dentists. Fragmin (dalteparin) can make you bleed more, so they might tell you to stop taking the medication for a short period of time if you are having a procedure done.

              • Let your provider know right away if you see any blood in your stool or urine, cough up or vomit blood, or have any bleeding that doesn’t stop.

                faqs

                Frequently asked questions about Fragmin (dalteparin)

                Is Fragmin (dalteparin) the same as heparin?
                Fragmin (dalteparin) belongs to a class of anticoagulants called low molecular weight heparins (LMWH). It works similar to heparin because it thins your blood to prevent blood clots. Since it's a LMWH, it has a different structure so it targets a more specific type of clotting protein. When given as a subcutaneous (under the skin) injection, Fragmin (dalteparin) is absorbed better, lasts longer, and requires fewer injections per day.
                Can I take Fragmin (dalteparin) with aspirin?
                It's usually recommended to avoid NSAID medications, like aspirin, because they can raise your risk of serious bleeding when taken with Fragmin (dalteparin). However, people who are taking Fragmin (dalteparin) for unstable angina or NSTEMI, should continue to take aspirin and other heart medications. As always, talk to your provider before starting or stopping any medications.
                Does Fragmin (dalteparin) have to be given at the same time each day?
                If you are injecting Fragmin (dalteparin) once a day, it can be injected at any time of the day, but it's important to do it at the same time every day. This will keep the amount of medication in your body at the right level.
                Does Fragmin (dalteparin) affect PT or INR?
                No, Fragmin (dalteparin) doesn't affect PT or INR, which are the lab values that are typically monitored for people taking heparin or warfarin. Fragmin (dalteparin) works on a specific protein called factor Xa and can be monitored with anti-Xa levels. Fragmin (dalteparin) isn't usually monitored except in certain high risk people, such as children, pregnant women, and people with kidney problems. Anti-Xa levels allow providers to make sure you're getting the right dose.
                Can I drink alcohol while taking Fragmin (dalteparin)?
                Some people with no major medical problems can have a drink once in a while, but first check with your provider. Keep in mind, however, that Fragmin (dalteparin) can raise your risk of bleeding, which can be extremely dangerous if you fall or hit your head while drinking. Before drinking alcohol, talk with your provider to make sure it's safe for you.
                Do Fragmin (dalteparin) injections hurt?
                About 5 out of 100 people in clinical studies reported having pain at the Fragmin (dalteparin) injection site. Rotate the site where you inject Fragmin (dalteparin) each time to help prevent pain and bruising.
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                What are the risks and warnings for Fragmin (dalteparin)?

                Fragmin (dalteparin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                risk-warning

                Bleeding around the spinal cord

                • Risk factors: Spinal puncture (spinal tap) | Getting anesthesia near the spine (epidural anesthesia) | History of spinal surgery | Also using nonsteroidal anti-inflammatory drugs (NSAIDs) or other blood thinners

                  If you're taking Fragmin (dalteparin) and are getting either a spinal tap or an epidural, you're at a greater risk of bleeding around your spinal cord, which can make you paralyzed. Your provider will tell you how to stop taking Fragmin (dalteparin) safely before you go through a back surgery or procedure. Call your provider right away if you notice pain, tingling, a burning sensation, numbness, weakness, or are unable to urinate.

                  risk-warning

                  Low platelet counts and clotting problems

                  • Risk factors: History of heparin-induced thrombocytopenia (HIT)

                    Fragmin (dalteparin) can cause your platelet counts to go down, and in rare cases, can cause a life-threatening condition called heparin-induced thrombocytopenia (HIT). HIT happens when the immune system creates antibodies that affect the function of platelets, causing blood clots to form in various parts of the body. If your platelets become very low, it's likely that Fragmin (dalteparin) will be stopped and your providers will consider a different blood thinner for you if needed.

                    dosage

                    Fragmin (dalteparin) dosage forms

                    Typical dosing for Fragmin (dalteparin)

                    Adults:

                    • Prevention of complications with unstable angina or NSTEMI: The typical dose is 120 units/kg injected under the skin every 12 hours (usually given with aspirin).

                    • Blood clot prevention after surgery or when you are very sick/bedridden: The typical dose range is 2,500 units injected under the skin every 4 to 8 hours and 5,000 units once daily. The dose will depend on your specific condition.

                    • Extended treatment in people with cancer: The typical dose is based on your weight and will be given once a day for 6 months. The dose in the first month will be larger than the doses for the remaining months.

                    Children: The dose is based on the child's age and weight, and will be given twice a day.

                    interactions

                    Interactions between Fragmin (dalteparin) and other drugs

                    Fragmin (dalteparin) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Fragmin (dalteparin). Please note that only the generic name of each medication is listed below.

                    Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                    • Defibrotide

                    Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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                    How much does Fragmin (dalteparin) cost?

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                    Fragmin (brand)
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                    alternatives

                    What are alternatives to Fragmin (dalteparin)?

                    There are a number of medications that your doctor can prescribe in place of Fragmin (dalteparin). Compare a few possible alternatives below.
                    Fragmin (dalteparin)
                    Used for:

                    • Blood clot prevention after abdominal surgery, after hip or knee replacement surgery, or when you are very sick and bedridden

                    • Prevention of complications in people with unstable angina or NSTEMI (a type of heart attack)

                    • Extended treatment of symptomatic blood clots to prevent future blood clots in people with cancer

                    • Treatment of symptomatic blood cots in children age 1 month or older

                    $1905.62 Lowest GoodRx priceView Prices
                    Warfarin (Coumadin)
                    Used for:

                    • Prevention and treatment blood clots in the veins

                    • Prevention and treatment blood clots linked to atrial fibrillation (AFib) or heart valve replacement

                    • Prevention of more blood clots and to lower risk of death after a heart attack

                    $4.00 Lowest GoodRx priceView Prices
                    Enoxaparin (Lovenox)
                    Used for:
                    $86.38 Lowest GoodRx priceView Prices

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