dalteparin sodium: clinical use

Prescribing considerations

• Confirm the licensed indication and select a presentation appropriate for age, pregnancy, breastfeeding, allergy status and administration setting.
• Assess bleeding risk, renal and hepatic function, platelet history and planned surgery or neuraxial procedures.
• Do not administer intramuscularly; avoid unnecessary intramuscular injections during anticoagulation.
• Dalteparin is not interchangeable unit-for-unit with unfractionated heparin, another low molecular weight heparin or a synthetic anticoagulant.
• The active substance is manufactured from porcine-derived heparin; discuss this where relevant to patient preference.

Contraindications and cautions

• Hypersensitivity to dalteparin, heparin or another low molecular weight heparin; the multidose vial is also contraindicated in benzyl alcohol hypersensitivity.
• Confirmed or suspected immune-mediated heparin-induced thrombocytopenia.
• Active significant bleeding, cerebral haemorrhage, acute gastroduodenal ulcer, serious coagulation disorders or haemorrhagic diathesis.
• Acute or subacute septic endocarditis.
• Relevant injury or surgery involving the central nervous system, eyes or ears.
• Local or regional anaesthesia for elective surgery when dalteparin is being used at treatment intensity.

Monitoring

• Check platelets before treatment and monitor regularly, remaining alert for a rapid or substantial fall suggesting heparin-induced thrombocytopenia.
• Monitor clinically for bleeding; haemoglobin and other investigations may be appropriate according to risk and setting.
• Routine anti-Xa monitoring is usually unnecessary in adults but should be considered in children, renal failure, pregnancy, extremes of body weight, or unusually high bleeding or rethrombosis risk.
• Measure potassium before treatment and during continued use in patients at risk of hyperkalaemia.
• Coordinate interruption and catheter procedures carefully around spinal or epidural anaesthesia.

Clinical pharmacology

Dalteparin is a porcine-derived low molecular weight heparin that potentiates antithrombin-mediated inhibition of factor Xa and thrombin. Subcutaneous bioavailability is high and elimination is mainly renal, so accumulation may occur with significant renal dysfunction.

Formulation and product differences

• The graduated pre-filled syringe is preservative-free, intended for single use and includes a needle-safety device; its needle shield may contain natural rubber latex.
• The multidose vial contains benzyl alcohol and has clinically relevant sodium content. Select preservative-free dalteparin for pregnancy, breastfeeding and young children where specified.
• Storage and in-use requirements differ between the single-dose syringe and multidose vial; follow product-specific instructions and local aseptic policy.

Injection

Route: Parenteral

Strengths: 2500 units/0.2 mL, 7500 units/0.3 mL, 10000 units/0.4 mL, 10000 units/mL, 12500 units/0.5 mL, 15000 units/0.6 mL, 18000 units/0.72 mL