lPREGNANCYDoes not cross the placenta; maternal
osteoporosis reported after prolonged use; multidose vials
may contain benzyl alcohol—some manufacturers advise
avoid.
lBREAST FEEDINGNot excreted into milk due to high
molecular weight.
lHEPATIC IMPAIRMENT
Dose adjustmentsRisk of bleeding increased—reduce dose
or avoid in severe impairment (including oesophageal
varices).
lRENAL IMPAIRMENT
Dose adjustmentsRisk of bleeding increased in severe
impairment—dose may need to be reduced.
lDIRECTIONS FOR ADMINISTRATIONForcontinuous
intravenous infusion, dilute with Glucose 5 % or Sodium
chloride 0. 9 %.
▶In neonatesFormaintenance of neonatal umbilical arterial
catheter, dilute 50 units to afinal volume of 50 mL with
Sodium Chloride 0. 45 % or use ready-made bag containing
500 units in 500 mL Sodium Chloride 0. 9 %; infuse at
0. 5 mL/hour. Forneonatal intensive care (treatment of
thrombosis), dilute 1250 units/kg body-weight to afinal
volume of 50 mL with infusionfluid; an intravenous
infusion rate of 1 mL/hour provides a dose of
25 units/kg/hour.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection, solution for
infusion
Solution for injection
EXCIPIENTS:May contain Benzyl alcohol
▶Heparin (unfractionated) (Non-proprietary)
Heparin sodium 1000 unit per 1 mlHeparin sodium 1 , 000 units/ 1 ml
solution for injection ampoules| 10 ampouleP£ 14. 85
Heparin sodium 5 , 000 units/ 5 ml solution for injection vials|
10 vialP£ 16. 50 – £ 37. 41
Heparin sodium 20 , 000 units/ 20 ml solution for injection ampoules|
10 ampouleP£ 70. 80 – £ 70. 88
Heparin sodium 5 , 000 units/ 5 ml solution for injection ampoules|
10 ampouleP£ 37. 45 – £ 37. 47
Heparin sodium 10 , 000 units/ 10 ml solution for injection ampoules|
10 ampouleP£ 64. 50 – £ 64. 59
Heparin sodium 5000 unit per 1 mlHeparin sodium 5 , 000 units/ 1 ml
solution for injection ampoules| 10 ampouleP£ 29. 04
Heparin sodium 25 , 000 units/ 5 ml solution for injection vials|
10 vialP£ 45. 00 – £ 84. 60
Heparin sodium 25 , 000 units/ 5 ml solution for injection ampoules|
10 ampouleP£ 75. 78
Heparin calcium 25000 unit per 1 mlHeparin calcium
5 , 000 units/ 0. 2 ml solution for injection ampoules| 10 ampouleP
£ 44. 70
Heparin sodium 25000 unit per 1 mlHeparin sodium
25 , 000 units/ 1 ml solution for injection ampoules| 10 ampouleP
£ 76. 95
Heparin sodium 5 , 000 units/ 0. 2 ml solution for injection ampoules|
10 ampouleP£ 37. 35
Form unstated
EXCIPIENTS:May contain Benzyl alcohol
▶Heparin (unfractionated) (Non-proprietary)
Heparin sodium 10 unit per 1 mlHeparin sodium 50 units/ 5 ml
patency solution ampoules| 10 ampouleP£ 14. 96 DT = £ 14. 96
Heparin sodium 50 units/ 5 ml I.V. flush solution ampoules|
10 ampouleP£ 14. 96 DT = £ 14. 96
Heparin sodium 100 unit per 1 mlHeparin sodium 200 units/ 2 ml I.V.
flush solution ampoules| 10 ampouleP£ 15. 68 DT = £ 15. 68
Heparin sodium 200 units/ 2 ml patency solution ampoules|
10 ampouleP£ 15. 68 DT = £ 15. 68
Infusion
▶Heparin (unfractionated) (Non-proprietary)
Heparin sodium 2 unit per 1 mlHeparin sodium 1 , 000 units/ 500 ml
infusion Viaflex bags| 1 bagPs
Heparin sodium 2 , 000 units/ 1 litre infusion Viaflex bags|
1 bagPs
Heparin sodium 5 unit per 1 mlHeparin sodium 5 , 000 units/ 1 litre
infusion Viaflex bags| 1 bagPseiiiiF 93Tinzaparin sodium
lINDICATIONS AND DOSE
Treatment of thrombotic episodes
▶BY SUBCUTANEOUS INJECTION
▶Child 1 month: 275 units/kg once daily
▶Child 2–11 months: 250 units/kg once daily
▶Child 1–4 years: 240 units/kg once daily
▶Child 5–9 years: 200 units/kg once daily
▶Child 10–17 years: 175 units/kg once daily
Treatment of venous thromboembolism in pregnancy
▶BY SUBCUTANEOUS INJECTION
▶Child 12–17 years: 175 units/kg once daily, dose based on
early pregnancy body-weight
Prophylaxis of thrombotic episodes
▶BY SUBCUTANEOUS INJECTION
▶Child: 50 units/kg once dailylUNLICENSED USENot licensed for the treatment of venous
thromboembolism in pregnancy.
Not licensed for use in children.
lINTERACTIONS→Appendix 1 : low molecular-weight
heparins
lSIDE-EFFECTS
▶Common or very commonAnaemia
▶Rare or very rareAngioedema.Stevens-Johnson syndrome
lPREGNANCYNot known to be harmful, low molecular
weight heparins do not cross the placenta. Vials contain
benzyl alcohol—manufacturer advises avoid.
lBREAST FEEDINGDue to the relatively high molecular
weight of tinzaparin and inactivation in the gastro-
intestinal tract, passage into breast-milk and absorption
by the nursing infant are likely to be negligible; however
manufacturer advise avoid.
lRENAL IMPAIRMENTRisk of bleeding may be increased.
Unfractionated heparin may be preferable. Manufacturer
advises caution if estimated glomerularfiltration rate less
than 30 mL/minute/ 1. 73 m^2.
MonitoringIn renal impairment monitoring of anti-Factor
Xa may be required if estimated glomerularfiltration rate
less than 30 mL/minute/ 1. 73 m^2.
lMONITORING REQUIREMENTSRoutine monitoring of anti-
Factor Xa activity is not usually required 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, sulfites
▶Tinzaparin sodium (Non-proprietary)
Tinzaparin sodium 10000 unit per 1 mlTinzaparin sodium
3 , 500 units/ 0. 35 ml solution for injection pre-filled syringes| 10 pre-
filled disposable injectionP£ 27. 71 DT = £ 27. 71
Tinzaparin sodium 4 , 500 units/ 0. 45 ml solution for injection pre-filled
syringes| 10 pre-filled disposable injectionP£ 35. 63 DT = £ 35. 63
Tinzaparin sodium 2 , 500 units/ 0. 25 ml solution for injection pre-filled
syringes| 10 pre-filled disposable injectionP£ 19. 80 DT = £ 19. 80
▶Innohep(LEO Pharma)
Tinzaparin sodium 10000 unit per 1 mlInnohep 20 , 000 units/ 2 ml
solution for injection vials| 10 vialP£ 105. 66 DT = £ 105. 66
Tinzaparin sodium 20000 unit per 1 mlInnohep 18 , 000 units/ 0. 9 ml
solution for injection pre-filled syringes| 6 pre-filled disposable
injectionP£ 64. 25 | 10 pre-filled disposable injectionP
£ 107. 08 DT = £ 107. 08
Innohep 8 , 000 units/ 0. 4 ml solution for injection pre-filled syringes|
6 pre-filled disposable injectionP£ 28. 56 | 10 pre-filled
disposable injectionP£ 47. 60 DT = £ 47. 60
Innohep 40 , 000 units/ 2 ml solution for injection vials| 1 vialP
£ 34. 20 DT = £ 34. 2096 Blood clots BNFC 2018 – 2019
Cardiovascular system2