This medicine is an anticoagulant used for preventing blood clots in patients who will be having certain types of surgery. This medicine is also used with warfarin to treat blood clots in the leg or lungs. It may also be used for other conditions as determined by your doctor.
Follow the directions for taking this medicine provided by your doctor. An additional patient information leaflet is available with this medicine. Ask your doctor, nurse, or pharmacist any questions that you may have about this information. This medicine is usually given as an injection at your doctor's office, hospital, or clinic. IF YOU WILL BE USING THIS MEDICINE AT HOME, a health care provider will teach you how to use it. Be sure you understand how to use this medicine. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions. DO NOT USE THIS MEDICINE if it contains particles, is cloudy or discolored, or if the syringe is cracked or damaged. Use the proper technique taught to you by your doctor. Inject deep under the skin, NOT into muscle. Use a different injection site each day to prevent problems at the injection site (eg, hematomas). STORE THIS MEDICINE at 77 degrees F (25 degrees C) away from heat, moisture, and light. Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Do not store in the bathroom. KEEP THIS PRODUCT, as well as syringes and needles, out of the reach of children and pets. IF YOU MISS A DOSE OF THIS MEDICINE, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. DO NOT use2 doses at once.
WARNING: Tell your doctor you use this medicine before you have any type of spinal puncture or epidural/spinal anesthesia. Patients who have these procedures while they use this medicine are at risk for developing a blood clot on or near the spinal cord. This could result in long-term or permanent paralysis. The risk is increased in patients who have an indwelling epidural catheter, traumatic or repeated epidural or spinal puncture, a history of a deformed spine or spinal surgery, and in patients who use medicines that may affect blood clotting such as warfarin, aspirin, platelet inhibitors (eg, clopidogrel), and nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, naproxen). If you have a spinal puncture or epidural/spinal anesthesia while you use this medicine, tell your doctor immediately if you notice any signs or symptoms of nerve problems such as numbness or tingling, muscle weakness, or paralysis. Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking activated protein C (eg, drotecogin alfa); anticoagulants (eg, warfarin); direct factor Xa inhibitors (eg, rivaroxaban); direct thrombin inhibitors (eg, dabigatran); nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, ketorolac, naproxen); platelet inhibitors (eg, clopidogrel, ticlopidine), or salicylates (eg, aspirin). DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions, including low body weight or a history of kidney problems, liver problems, stomach or intestinal problems (eg, ulcers), stroke, vision problems caused by diabetes, a bleeding disorder, brain bleeding or blood conditions, severe or uncontrolled high blood pressure, allergies, pregnancy, or breast-feeding. Tell your doctor if you have recently had or are scheduled to have brain, spine, or eye surgery; an epidural catheter; or a spinal puncture. USE OF THIS MEDICINE IS NOT RECOMMENDED if you have severe kidney problems, inflammation of the heart due to a bacterial infection (eg, bacterial endocarditis), active major bleeding, severe bleeding problems, or if you have a low platelet count and the presence of antiplatelet antibodies. IF YOU WEIGH LESS THAN 110 POUNDS (50 KG), USE OF THE MEDICINE IS NOT RECOMMENDED if you are using this medicine to treat a blood clot in the lungs or legs, you will be having hip or knee replacement surgery or abdominal surgery, or you have had a hip fracture. Contact your doctor or pharmacist if you have any questions or concerns about using this medicine.
SIDE EFFECTS that may occur while taking this medicine include mild bleeding, irritation, rash, or itching at the injection site; or trouble sleeping. If they continue or are bothersome, check with your doctor. CONTACT YOUR DOCTOR IMMEDIATELY if you experience bloody, black, tarry stools; confusion; difficulty walking; fainting; fever; increased drainage or oozing from a wound; loss of appetite; nosebleed; one-sided weakness; pale skin; pink or red urine; severe or persistent dizziness or headache; severe or persistent tiredeness, weakness, nausea, or vomiting; slurred speech; swelling of the ankles, feet, or hands; tingling, numbness (especially in the legs and feet) and muscle weakness; unusual or severe bleeding or bruising; or vomit that looks like coffee grounds. AN ALLERGIC REACTION to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your healthcare provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include excessive bleeding and bruising.
DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. DO NOT reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor, nurse, or pharmacist to explain local regulations for selecting an appropriate container and properly disposing of the container when it is full.