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Fragmin Dosage

Generic name: DALTEPARIN SODIUM 2500[iU] in 0.2mL
Dosage form: injection
Drug class: Heparins

Medically reviewed by Drugs.com. Last updated on Nov 12, 2024.

Recommended Dosage for Prophylaxis of Ischemic Complications in Unstable Angina and Non-Q-Wave Myocardial Infarction

In patients with unstable angina or non-Q-wave myocardial infarction, the recommended dose of FRAGMIN Injection is 120 units/kg of body weight, but not more than 10,000 units, subcutaneously every 12 hours with concurrent oral aspirin (75 mg to 165 mg once daily) therapy. Treatment should be continued until the patient is clinically stabilized. The usual duration of administration is 5 days to 8 days. Concurrent aspirin therapy is recommended except when contraindicated.

Table 1 lists the volume of FRAGMIN in mL (based on the 3.8 mL multiple-dose vial 25,000 units/mL) and quantity of FRAGMIN in units, to be administered for a range of patient weights.

Table 1

Quantity and Volume of FRAGMIN to be Administered by Patient Weight

Patient weight (kg)

<50 kg

50 kg to 59 kg

60 kg to 69 kg

70 kg to 79 kg

80 kg to 89 kg

≥90 kg

Quantity of FRAGMIN (units)

5,500 units

6,500 units

7,500 units

9,000 units

10,000 units

10,000 units

Volume of FRAGMIN (mL)
95,000 units / 3.8 mL

0.22 mL

0.26 mL

0.3 mL

0.36 mL

0.4 mL

0.4 mL

Prophylaxis of Deep Vein Thrombosis

Prophylaxis of VTE Following Hip Replacement Surgery: Table 2 presents the dosing options for patients undergoing hip replacement surgery. The usual duration of administration is 5 days to 10 days after surgery; up to 14 days of treatment with FRAGMIN have been well tolerated in clinical trials.

Table 2
Dosing Options for Patients Undergoing Hip Replacement Surgery
*
Or later, if hemostasis has not been achieved.
†
Up to 14 days of treatment was well tolerated in controlled clinical trials, where the usual duration of treatment was 5 days to 10 days postoperatively.
‡
Allow a minimum of 6 hours between this dose and the dose to be given on Postoperative Day 1. Adjust the timing of the dose on Postoperative Day 1 accordingly.
§
Allow approximately 24 hours between doses.

Timing of First Dose of FRAGMIN

Dose of FRAGMIN to be Given Subcutaneously

10 Hours to 14 Hours Before Surgery

Within 2 Hours Before Surgery

4 Hours to 8 Hours After Surgery*

Postoperative Period†

Postoperative Start

---

---

2,500 units‡

5,000 units once daily

Preoperative Start - Day of Surgery

---

2,500 units

2,500 units‡

5,000 units once daily

Preoperative Start - Evening Before Surgery§

5,000 units

---

5,000 units

5,000 units once daily

Abdominal Surgery: In patients undergoing abdominal surgery with a risk of thromboembolic complications, the recommended dose of FRAGMIN is 2,500 units administered by subcutaneous injection once daily, starting 1 hour to 2 hours prior to surgery and repeated once daily postoperatively. The usual duration of administration is 5 days to 10 days.

In patients undergoing abdominal surgery associated with a high risk of thromboembolic complications, such as malignant disorder, the recommended dose of FRAGMIN is 5,000 units subcutaneously the evening before surgery, then once daily postoperatively. The usual duration of administration is 5 days to 10 days. Alternatively, in patients with malignancy, 2,500 units of FRAGMIN can be administered subcutaneously 1 hour to 2 hours before surgery followed by 2,500 units subcutaneously 12 hours later, and then 5,000 units once daily postoperatively. The usual duration of administration is 5 days to 10 days.

Medical Patients During Acute Illness: In medical patients with severely restricted mobility during acute illness, the recommended dose of FRAGMIN is 5,000 units administered by subcutaneous injection once daily. In clinical trials, the usual duration of administration was 12 days to 14 days.

Extended Treatment of Symptomatic Venous Thromboembolism (VTE) in Adult Patients with Cancer

In adult patients with cancer and symptomatic VTE, the recommended dosing of FRAGMIN is as follows: for the first 30 days of treatment administer FRAGMIN 200 units/kg total body weight subcutaneously once daily. The total daily dose should not exceed 18,000 units. Table 3 lists the dose of FRAGMIN to be administered once daily during the first month for a range of patient weights.

Month 1

Table 3
Dose of FRAGMIN to be Administered Subcutaneously by Patient Weight during the First Month

Body Weight (kg)

FRAGMIN Dose (units)
(prefilled syringe) once daily

≤56 kg

10,000 units

57 kg to 68 kg

12,500 units

69 kg to 82 kg

15,000 units

83 kg to 98 kg

18,000 units

≥99 kg

18,000 units

Months 2 to 6

Administer FRAGMIN at a dose of approximately 150 units/kg, subcutaneously once daily during Months 2 through 6. The total daily dose should not exceed 18,000 units. Table 4 lists the dose of FRAGMIN to be administered once daily for a range of patient weights during months 2 to 6.

Table 4
Dose of FRAGMIN to be Administered Subcutaneously by Patient Weight during Months 2 to 6

Body Weight (kg)

FRAGMIN Dose (units)
(prefilled syringe)
once daily

≤56 kg

7,500 units

57 kg to 68 kg

10,000 units

69 kg to 82 kg

12,500 units

83 kg to 98 kg

15,000 units

≥99 kg

18,000 units

Safety and efficacy beyond six months have not been evaluated in patients with cancer and acute symptomatic VTE.

Treatment of Symptomatic Venous Thromboembolism (VTE) in Pediatric Patients

The recommended starting dose according to pediatric age is provided in Table 5.

Table 5
Starting Doses for Pediatric Patients with Symptomatic VTE

Age Group

Starting Dose

​Birth (gestational age at least 35 weeks) to less than 2 Years

150 units/kg twice daily
2 Years to less than 8 Years

125 units/kg twice daily
8 Years to less than 17 Years

100 units/kg twice daily

After initiation of FRAGMIN, measure anti-Xa level prior to the 4th dose. Samples for anti-Xa level should be drawn 4 hours after administration of FRAGMIN. Adjust doses in increments of 25 units/kg to achieve target anti-Xa level between 0.5 units/mL and 1 unit/mL. Individualize the maintenance dose of FRAGMIN based on the dose that achieves target anti-Xa level collected 4 hours after administration of FRAGMIN. Monitor anti-Xa level periodically in pediatric patients to maintain anti-Xa level between 0.5 units/mL and 1 unit/mL.

The 3.8 mL multiple-dose vials of FRAGMIN contain 14 mg/mL of benzyl alcohol.

Whenever possible, administer benzyl alcohol-free formulations (prefilled syringes) in pediatric patients.

The 10,000 units/4 mL (2,500 units/mL) single-dose vials are preservative-free. For treatment of neonates, use this vial presentation.

Dose Reductions for Thrombocytopenia in Adult Patients with Cancer and in Pediatric Patients with Symptomatic VTE

Dose reductions recommended in patients receiving FRAGMIN who experience thrombocytopenia are presented below in Table 6.

Table 6

Platelet Count less than or equal to 50,000/mm3

Platelet Count greater than 50,000/mm3 up to 100,000/mm3

Adults

Discontinue FRAGMIN until platelet count recovers to above 50,000/mm3.

Reduce the daily dose of FRAGMIN by 2,500 units until the platelet count recovers to greater or equal to 100,000/mm3.

Children ​from birth (gestational age at least 35 weeks) to less than 17 Years

Discontinue FRAGMIN until platelet count recovers to above 50,000/mm3.

Reduce the daily dose of FRAGMIN by 50% until the platelet count recovers to greater or equal to 100,000/mm3.

Dose Reductions for Renal Insufficiency in Extended Treatment of Acute Symptomatic VTE in Adult Patients with Cancer

In patients with severely impaired renal function (CrCl <30 mL/min), monitor anti-Xa levels to determine the appropriate FRAGMIN dose. Target anti-Xa range is 0.5 units/mL to 1.5 units/mL. When monitoring anti-Xa in these patients, perform sampling 4 hours to 6 hours after FRAGMIN dosing and only after the patient has received 3 to 4 doses [see Clinical Pharmacology (12.3)].

Administration

Latex Allergy: Persons with latex allergies should not handle the FRAGMIN prefilled syringe because the needle shield may contain natural rubber latex which may cause allergic reactions.

FRAGMIN is administered by subcutaneous injection. It must not be administered by intramuscular injection.

FRAGMIN Injection should not be mixed with other injections or infusions unless specific compatibility data are available that support such mixing.

Subcutaneous injection technique: Patients should be sitting or lying down and FRAGMIN administered by deep subcutaneous injection. FRAGMIN may be injected in a U-shape area around the navel, the upper outer side of the thigh or the upper outer quadrangle of the buttock. The injection site should be varied daily. When the area around the navel or the thigh is used, using the thumb and forefinger, you must lift up a fold of skin while giving the injection. The entire length of the needle should be inserted at a 45 to 90 degree angle.

Inspect FRAGMIN prefilled syringes and vials visually for particulate matter and discoloration prior to administration.

After first penetration of the rubber stopper, store the multiple-dose vials at room temperature for up to 2 weeks. Discard any unused solution after 2 weeks.

Instructions for using the prefilled single-dose syringes preassembled with needle guard devices

Figure

Fixed dose syringes: To ensure delivery of the full dose, do not expel the air bubble from the prefilled syringe before injection. Hold the syringe assembly by the open sides of the device. Remove the needle shield. Insert the needle into the injection area as instructed above. Depress the plunger of the syringe while holding the finger flange until the entire dose has been given. The needle guard will not be activated unless the entire dose has been given. Remove needle from the patient. Let go of the plunger and allow syringe to move up inside the device until the entire needle is guarded. Discard the syringe assembly in approved containers.

Graduated syringes: Hold the syringe assembly by the open sides of the device. Remove the needle shield. With the needle pointing up, prepare the syringe by expelling the air bubble and then continuing to push the plunger to the desired dose or volume, discarding the extra solution in an appropriate manner. Insert the needle into the injection area as instructed above. Depress the plunger of the syringe while holding the finger flange until the entire dose remaining in the syringe has been given. The needle guard will not be activated unless the entire dose has been given. Remove needle from the patient. Let go of the plunger and allow syringe to move up inside the device until the entire needle is guarded. Discard the syringe assembly in approved containers.

Further information

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