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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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