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Dalteparin Sodium: Brands, Price & Uses in Bangladesh
Established (FDA-Approved) Indications Prophylaxis of deep vein thrombosis (DVT): In patients undergoing abdominal surgery who are at risk of thromboembolic complications and more.
About Dalteparin Sodium
Indications of Dalteparin Sodium
Established (FDA-Approved) Indications
- Prophylaxis of deep vein thrombosis (DVT): In patients undergoing abdominal surgery who are at risk of thromboembolic complications, in patients undergoing hip replacement surgery, and in medical patients with severely restricted mobility during acute illness.
- Prevention of clot formation in the extracorporeal circuit during hemodialysis or hemofiltration.
- Treatment of unstable angina and non-Q-wave myocardial infarction: Used in conjunction with aspirin to prevent progression to myocardial infarction or death.
- Extended treatment of symptomatic venous thromboembolism (proximal DVT and/or pulmonary embolism): To reduce the recurrence of VTE in patients with cancer.
Guideline-Supported / Off-Label Use
- Dalteparin Sodium is also used off-label, based on clinical guidelines, for anticoagulation during pregnancy (e.g., treatment or prophylaxis of VTE in pregnant women, where warfarin and direct oral anticoagulants are avoided) and for VTE treatment/prophylaxis in select pediatric patients under specialist supervision.
Dalteparin Sodium must always be used under medical supervision, with the specific dose and duration individualized to the indication, body weight, and bleeding risk of the patient.
Dosage & Administration of Dalteparin Sodium
Dosing by Indication (Adults)
| Indication | Typical Dose | Duration |
|---|---|---|
| Abdominal surgery – general risk of thromboembolism | 2,500 IU subcutaneously 1–2 hours before surgery, then 2,500 IU once daily | 5–10 days |
| Abdominal surgery – high risk (e.g., malignancy) | 5,000 IU subcutaneously the evening before surgery, then 5,000 IU once daily | 5–10 days |
| Hip replacement surgery | 2,500 IU pre-operatively and 2,500 IU postoperatively (or 5,000 IU the evening before surgery), followed by 5,000 IU once daily | 5–10 days; may be extended up to 35 days for prolonged prophylaxis |
| Medical patients with severely restricted mobility during acute illness | 5,000 IU subcutaneously once daily | 12–14 days |
| Unstable angina / non-Q-wave myocardial infarction | 120 IU/kg subcutaneously every 12 hours (maximum 10,000 IU per dose), together with aspirin | Usually 5–8 days |
| Extended treatment of cancer-associated VTE | Month 1: 200 IU/kg once daily (maximum 18,000 IU/day); Months 2–6: approximately 150 IU/kg once daily (dose reduced for treatment-related thrombocytopenia per labeling) | Up to 6 months, with periodic reassessment |
| Hemodialysis/hemofiltration (prevention of clotting in extracorporeal circuit) | Individualized loading and maintenance doses per dialysis protocol, as directed by the treating physician | For duration of each dialysis session |
Administration
Dalteparin Sodium is given by subcutaneous injection into the anterolateral or posterolateral abdominal wall, alternating sides, with the patient lying or sitting comfortably. It must not be given by intramuscular injection. Do not expel the air bubble from pre-filled syringes prior to injection, and do not rub the injection site afterward.
Renal Impairment
Dalteparin Sodium is renally cleared; in patients with severe renal impairment (e.g., creatinine clearance below 30 mL/min), especially those on treatment (not prophylactic) doses, dose reduction and monitoring of anti-Factor Xa levels are recommended due to the risk of drug accumulation and bleeding. See Precautions and Warnings for the boxed warning on spinal/epidural hematoma.
Side Effects of Dalteparin Sodium
Common
- Bleeding (ranging from minor bruising to serious hemorrhage)
- Injection site reactions: pain, hematoma, erythema, and irritation
- Mild, transient, asymptomatic elevation of liver transaminases
Less Common / Serious
- Thrombocytopenia, including immune-mediated heparin-induced thrombocytopenia (HIT)
- Hypersensitivity reactions (rash, urticaria, rarely anaphylaxis)
- Skin necrosis at the injection site (rare)
- Spinal or epidural hematoma in patients undergoing neuraxial anesthesia or spinal puncture (rare but can cause long-term or permanent paralysis; see Precautions and Warnings)
- Alopecia (rare)
- Osteoporosis with prolonged (months) use (rare)
Patients should seek prompt medical attention for unusual bruising, prolonged bleeding, black or bloody stools, severe headache, or signs of numbness/weakness while on Dalteparin Sodium.
Contraindications of Dalteparin Sodium
- Known hypersensitivity to Dalteparin Sodium, other low molecular weight heparins, heparin, or pork/porcine products.
- Active, uncontrolled major bleeding (e.g., active gastric or duodenal ulcer with bleeding, hemorrhagic stroke).
- Current or history of heparin-induced thrombocytopenia (HIT) or HIT with thrombosis (HITT) where Dalteparin Sodium shows cross-reactivity on in vitro platelet testing.
- Severe, uncontrolled hypertension where the bleeding risk is considered unacceptable.
- Hypersensitivity to benzyl alcohol (relevant to multi-dose vials); such vials must not be used in neonates or infants.
Dalteparin Sodium is not intended for intramuscular injection and is not interchangeable (unit for unit) with unfractionated heparin or other low molecular weight heparins.
Frequently Asked Questions about Dalteparin Sodium
What is Dalteparin Sodium used for?
Dalteparin Sodium is a low molecular weight heparin (anticoagulant, or "blood thinner") used to prevent and treat blood clots such as deep vein thrombosis (DVT), to prevent clotting during hemodialysis, to treat unstable angina and certain heart attacks together with aspirin, and for extended treatment of blood clots in patients with cancer.
How is Dalteparin Sodium given?
Dalteparin Sodium is given as a subcutaneous (under-the-skin) injection, usually into the abdomen, and is not given into a muscle. The dose and schedule depend on why you are taking it and your body weight, so always follow your physician's or nurse's instructions.
Can Dalteparin Sodium be used during pregnancy or breastfeeding?
Dalteparin Sodium should be used in pregnancy only if a physician determines it is clearly needed, since safety data are limited; it is generally considered compatible with breastfeeding in low amounts, but you should consult your physician before use during pregnancy or while nursing.
Who should not take Dalteparin Sodium?
Dalteparin Sodium should not be used by people with active major bleeding, a history of heparin-induced thrombocytopenia (HIT) that reacts with Dalteparin Sodium, known allergy to Dalteparin Sodium, heparin, or pork/porcine products, or severe uncontrolled hypertension. Tell your doctor about any allergies or bleeding disorders before starting Dalteparin Sodium.
What are the main risks of Dalteparin Sodium if I need spinal or epidural anesthesia?
Dalteparin Sodium carries a boxed warning: if you receive spinal or epidural anesthesia or a spinal puncture while on Dalteparin Sodium, there is a risk of a spinal or epidural hematoma (a collection of blood pressing on the spinal cord), which can cause long-term or permanent paralysis. Your medical team will carefully time your Dalteparin Sodium doses around any such procedure and monitor you closely for numbness, weakness, or loss of bladder/bowel control.
What should I do if I miss a dose or suspect an overdose of Dalteparin Sodium?
If you miss a dose of Dalteparin Sodium, contact your physician for advice rather than doubling the next dose. If an overdose is suspected, signs would mainly include unusual bleeding or bruising; seek immediate medical attention or contact emergency services/poison control right away.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.