BNF for Children (BNFC) 2018-2019

alternative anticoagulant, such as danaparoid, should be

given. Ensure platelet counts return to normal range in

those who require warfarin.

HyperkalaemiaInhibition of aldosterone secretion by

unfractionated or low molecular weight heparin can result

in hyperkalaemia; patients with diabetes mellitus, chronic

renal failure, acidosis, raised plasma potassium or those

taking potassium-sparing drugs seem to be more

susceptible. The risk appears to increase with duration of

therapy.

lALLERGY AND CROSS-SENSITIVITYHypersensitivity to

unfractionated or low molecular weight heparin.

lMONITORING REQUIREMENTS

▶Heparin-induced thrombocytopeniaPlatelet counts should be

measured just before treatment with unfractionated or low

molecular weight heparin, and regular monitoring of

platelet counts may be required if given for longer than

4 days. See the British Society for Haematology’s

Guidelines on the diagnosis and management of heparin-

induced thrombocytopenia: second edition.Br J Haematol

2012 ; 159 : 528 – 540.

▶HyperkalaemiaPlasma-potassium concentration should be

measured in patients at risk of hyperkalaemia before

starting the heparin and monitored regularly thereafter,

particularly if treatment is to be continued for longer than

7 days.

eiiiiF 93

Dalteparin sodium

lINDICATIONS AND DOSE

Treatment of thrombotic episodes

▶BY SUBCUTANEOUS INJECTION

▶Neonate: 100 units/kg twice daily.

▶Child 1 month–11 years: 100 units/kg twice daily

▶Child 12–17 years: 200 units/kg once daily (max. per dose

18 000units); reduced to 100 units/kg twice daily, dose

reduced if increased risk of bleeding

Treatment of venous thromboembolism in pregnancy

▶BY SUBCUTANEOUS INJECTION

▶Child 12–17 years (body-weight up to 50 kg): 5000 units

twice daily, use body-weight in early pregnancy to

calculate the dose

▶Child 12–17 years (body-weight 50–69 kg): 6000 units

twice daily, use body-weight in early pregnancy to

calculate the dose

▶Child 12–17 years (body-weight 70–89 kg): 8000 units

twice daily, use body-weight in early pregnancy to

calculate the dose

▶Child 12–17 years (body-weight 90 kg and

above):10 000units twice daily, use body-weight in

early pregnancy to calculate the dose

Prophylaxis of thrombotic episodes.

▶BY SUBCUTANEOUS INJECTION

▶Neonate: 100 units/kg once daily.

▶Child 1 month–11 years: 100 units/kg once daily

▶Child 12–17 years: 2500 – 5000 units once daily

lUNLICENSED USENot licensed for treatment of venous

thromboembolism in pregnancy.

Not licensed for use in children.

lINTERACTIONS→Appendix 1 : low molecular-weight

heparins

lPREGNANCYNot known to be harmful, low molecular

weight heparins do not cross the placenta. Multidose vial

contains benzyl alcohol—manufacturer advises avoid.

lBREAST FEEDINGDue to the relatively high molecular

weight and inactivation in the gastro-intestinal tract,

passage into breast-milk and absorption by the nursing

infant are likely to be negligible, however manufacturers

advise avoid.

lHEPATIC IMPAIRMENT

Dose adjustmentsDose reduction may be required in

severe impairment—risk of bleeding may be increased.

lRENAL IMPAIRMENTUse of unfractionated heparin may be

preferable.

Dose adjustmentsRisk of bleeding may be increased—dose

reduction may be required.

lMONITORING REQUIREMENTSRoutine monitoring of anti-

Factor Xa activity is not usually required during treatment

with dalteparin, except in neonates; monitoring may also

be necessary in severely ill children and those with renal or

hepatic impairment.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Solution for injection

EXCIPIENTS:May contain Benzyl alcohol

▶Dalteparin sodium (Non-proprietary)

Dalteparin sodium 10000 unit per 1 mlDalteparin sodium

10 , 000 units/ 1 ml solution for injection pre-filled syringes| 5 pre-filled

disposable injectionPsDT = £ 28. 23

Dalteparin sodium 12500 unit per 1 mlDalteparin sodium

2 , 500 units/ 0. 2 ml solution for injection pre-filled syringes| 10 pre-

filled disposable injectionPsDT = £ 18. 58

Dalteparin sodium 25000 unit per 1 mlDalteparin sodium

7 , 500 units/ 0. 3 ml solution for injection pre-filled syringes| 10 pre-

filled disposable injectionPsDT = £ 42. 34

Dalteparin sodium 12 , 500 units/ 0. 5 ml solution for injection pre-filled

syringes| 5 pre-filled disposable injectionPsDT = £ 35. 29

Dalteparin sodium 5 , 000 units/ 0. 2 ml solution for injection pre-filled

syringes| 10 pre-filled disposable injectionPsDT = £ 28. 23

Dalteparin sodium 15 , 000 units/ 0. 6 ml solution for injection pre-filled

syringes| 5 pre-filled disposable injectionPsDT = £ 42. 34

Dalteparin sodium 10 , 000 units/ 0. 4 ml solution for injection pre-filled

syringes| 5 pre-filled disposable injectionPsDT = £ 28. 23

Dalteparin sodium 18 , 000 units/ 0. 72 ml solution for injection pre-filled

syringes| 5 pre-filled disposable injectionPsDT = £ 50. 82

▶Fragmin(Pfizer Ltd)

Dalteparin sodium 2500 unit per 1 mlFragmin 10 , 000 units/ 4 ml

solution for injection ampoules| 10 ampouleP£ 51. 22

Dalteparin sodium 10000 unit per 1 mlFragmin 10 , 000 units/ 1 ml

solution for injection pre-filled syringes| 5 pre-filled disposable

injectionP£ 28. 23 DT = £ 28. 23

Fragmin 10 , 000 units/ 1 ml solution for injection ampoules|

10 ampouleP£ 51. 22

Dalteparin sodium 12500 unit per 1 mlFragmin 2 , 500 units/ 0. 2 ml

solution for injection pre-filled syringes| 10 pre-filled disposable

injectionP£ 18. 58 DT = £ 18. 58

Dalteparin sodium 25000 unit per 1 mlFragmin

18 , 000 units/ 0. 72 ml solution for injection pre-filled syringes| 5 pre-

filled disposable injectionP£ 50. 82 DT = £ 50. 82

Fragmin 15 , 000 units/ 0. 6 ml solution for injection pre-filled syringes|

5 pre-filled disposable injectionP£ 42. 34 DT = £ 42. 34

Fragmin 5 , 000 units/ 0. 2 ml solution for injection pre-filled syringes|

10 pre-filled disposable injectionP£ 28. 23 DT = £ 28. 23

Fragmin 12 , 500 units/ 0. 5 ml solution for injection pre-filled syringes|

5 pre-filled disposable injectionP£ 35. 29 DT = £ 35. 29

Fragmin 7 , 500 units/ 0. 3 ml solution for injection pre-filled syringes|

10 pre-filled disposable injectionP£ 42. 34 DT = £ 42. 34

Fragmin 100 , 000 units/ 4 ml solution for injection vials| 1 vialP

£ 48. 66

Fragmin 10 , 000 units/ 0. 4 ml solution for injection pre-filled syringes|

5 pre-filled disposable injectionP£ 28. 23 DT = £ 28. 23

eiiiiF 93

Enoxaparin sodium

lINDICATIONS AND DOSE

Treatment of thrombotic episodes

▶BY SUBCUTANEOUS INJECTION

▶Neonate: 1. 5 – 2 mg/kg twice daily.

▶Child 1 month: 1. 5 mg/kg twice daily

▶Child 2 months–17 years: 1 mg/kg twice daily

94 Blood clots BNFC 2018 – 2019

Cardiovascular system

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