tinzaparin sodium.txt

CLINICAL USE

Peri- and postoperative surgical thromboprophylaxis Treatment of DVT and pulmonary embolism Prevention of thrombus formation in extracorporeal circulation during

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :

DOSE IN NORMAL RENAL FUNCTION

General surgery: (low-moderate risk) 3500 IU daily Orthopaedic surgery: (high risk) 50 IU/kg or 4500 IU daily DVT and PE: 175 IU/kg bodyweight once daily for at least 6 days and until adequate oral anticoagulation is established

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 5500–7500 (average 6500)

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 14

%Excreted unchanged in urine &nbsp &nbsp : 80–90

Volume of distribution (L/kg) &nbsp &nbsp &nbsp : 3.1–5 litres

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp : 1.5/5.2 (detectable anti-Factor Xa activity persists for 24 hours)

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function.

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp: Not dialysed. Dose as in GFR<20 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : Not dialysed. Dose as in GFR<20 mL/min

HDF/high flux &nbsp : Dialysed. Dose as in GFR<20 mL/min

CAV/VVHD &nbsp &nbsp &nbsp: Not dialysed. Dose as in GFR=

20 to 50

mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of bleeding with NSAIDs – avoid concomitant use with IV diclofenac; increased risk of haemorrhage with ketorolac – avoid concomitant use

Nitrates: anticoagulant effect reduced by infusions of glyceryl trinitrate Drotrecogin alfa: manufacturer advises to avoid use of high doses of heparin with drotrecogin alfa Use with care in patients receiving oral anticoagulants, platelet aggregation inhibitors, aspirin or dextran

Reconstition

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Route

SC injection IV bolus/infusion

Rate of Administration

Comments

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OTHER INFORMATION

Tinzaparin is also indicated for prevention of clotting in the extracorporeal circulation during haemodialysis Dose for >4 hr session: IV bolus — (into arterial side of the dialyser or intravenously) of 3500–4500 IU Dose for 20 mL/min for 10 days without any accumulation (Nagge J. Is impaired renal function a contraindication to the use of low-molecular weight heparin? Arch Intern Med. 2002; 162: 2605–09.) (Siguret V. Elderly patients treated with tinzaparin (Innohep) administered once daily (175 anti-Xa IU/kg): anti-Xa and anti-IIa activities over 10 days. Thromb Haemostat. 2000; 84: 800–04.) Additional doses may be required if using LMWHs for anticoagulation in HDF Use 1 mg of protamine for every 100 anti-Xa IU to neutralise the effects of tinzaparin. If prothrombin time is still raised 2–4 hours later, give 0.5 mg/kg infusion of protamine . TioGUAninE 729 Tioguanine

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