Fondaparinux sodium

CLINICAL USE

Prophylaxis of deep vein thrombosis Treatment of deep vein thrombosis, pulmonary embolism, unstable angina and after a myocardial infarction

DOSE IN NORMAL RENAL FUNCTION

Prophylaxis DVT: Surgical: 2.5 mg 6 hours after surgery, —then 2.5 mg dailyMedical: 2.5 mg daily —Treatment DVT and PE: <50 kg: 5 mg daily —50–100 kg: 7.5 mg daily —>100 kg: 10 mg daily —

PHARMACOKINETICS

Molecular weight :1728

%Protein binding :97–98.6 (to antithrombin)

%Excreted unchanged in urine : 64–77

Volume of distribution (L/kg) :0.1–0.12

half-life – normal/ESRD (hrs) :17–21/72

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Prophylactic dose: 1.5 mg daily. See ‘Other Information’

10 to 20 : Reduce dose.

<10 : Reduce dose.

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD :Dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsIncreased risk of bleeding in combination with any other drugs that affect coagulation

ADMINISTRATION

Reconstition

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Route

Rate of Administration

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Comments

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OTHER INFORMATION

In patients with a GFR of 30–50 mL/min and weight >100 kg, give an initial dose of 10 mg then reduce to 7.5 mg daily for treatment of a DVT; use with cautionManufacturer advises to avoid in severe renal impairment due to increased risk of bleedingClearance of fondaparinux increases by up to 20% during haemodialysisHas been used successfully at a dose of 2.5 mg instilled into the dialysis circuit for anticoagulation during dialysis

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