fondaparinux (Rx)

Brand and Other Names:Arixtra
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

prefilled syringe

  • 2.5mg/0.5mL
  • 5mg/0.4mL
  • 7.5mg/0.6mL
  • 10mg/0.8mL

Deep Vein Thrombosis/Acute Pulmonary Embolism

Treatment

  • <50 kg: 5 mg SC once daily
  • 50-100 kg: 7.5 mg SC once daily
  • >100 kg: 10 mg SC once daily
  • Administer for 5-9 days; up to 26 days administered in clinical trials

Prophylaxis

  • >50 kg: 2.5 mg SC once daily for 5-9 days or up to 10 days following abdomonal surgery; for hip replacement, 11 days recommended and a minimum 10-14 days recommended for patients undergoing total hip or knee arthroplasty, or hip fracture surgery; administered for up to 35 days in some instances

VTE Prophylaxis With History of HIT (Off-label)

Prophylaxis of deep vein thrombosis (DVT) in patient with history of heparin-induced thrombocytopenia (HIT) until patient can switch to warfarin

2.5 mg SC once daily for 5-10 days

American College of Chest Physicians (ACCP) guidelines assign low evidence rating to treatment of HIT with fondaparinux and conclude that further studies evaluating its role in HIT treatment are needed

Administration

Administer initial dose 6-8 hours after surgery, once hemostasis has been established

SC administration is deep, alternating right and left anterior and posterior abdominal walls

Safety and efficacy not established

Because bleeding is increased in adults <50 kg, bleeding may be a particular safety concern in children

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Interactions

Interaction Checker

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            Contraindicated (3)

            • apixaban

              fondaparinux and apixaban both increase anticoagulation. Contraindicated. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • defibrotide

              defibrotide increases effects of fondaparinux by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

            • mifepristone

              mifepristone, fondaparinux. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.

            Serious - Use Alternative (62)

            • abciximab

              fondaparinux, abciximab. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • amobarbital

              amobarbital decreases effects of fondaparinux by increasing metabolism. Avoid or Use Alternate Drug.

            • anagrelide

              fondaparinux, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • antithrombin alfa

              antithrombin alfa and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • antithrombin III

              antithrombin III and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • argatroban

              argatroban and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • azithromycin

              azithromycin increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

            • bazedoxifene/conjugated estrogens

              bazedoxifene/conjugated estrogens decreases effects of fondaparinux by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • bemiparin

              bemiparin and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • betrixaban

              fondaparinux, betrixaban. Either increases levels of the other by anticoagulation. Contraindicated. Therapeutic duplication; may use temporarily when switching anticoagulants.

            • bivalirudin

              bivalirudin and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • butabarbital

              butabarbital decreases effects of fondaparinux by increasing metabolism. Avoid or Use Alternate Drug.

            • butalbital

              butalbital decreases effects of fondaparinux by increasing metabolism. Avoid or Use Alternate Drug.

            • cefamandole

              cefamandole increases effects of fondaparinux by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cefazolin

              cefazolin increases effects of fondaparinux by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cefdinir

              cefdinir increases effects of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cefditoren

              cefditoren will increase the level or effect of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefotetan

              cefotetan increases effects of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cefoxitin

              cefoxitin will increase the level or effect of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefpodoxime

              cefpodoxime will increase the level or effect of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • ceftriaxone

              ceftriaxone increases effects of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cefuroxime

              cefuroxime will increase the level or effect of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cilostazol

              fondaparinux, cilostazol. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • clarithromycin

              clarithromycin increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

            • clopidogrel

              fondaparinux, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • conjugated estrogens

              conjugated estrogens decreases effects of fondaparinux by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • dabigatran

              dabigatran and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • dalteparin

              dalteparin and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • dipyridamole

              fondaparinux, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • enoxaparin

              enoxaparin and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • eptifibatide

              fondaparinux, eptifibatide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • erythromycin base

              erythromycin base increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              erythromycin lactobionate increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin stearate

              erythromycin stearate increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

            • estradiol

              estradiol decreases effects of fondaparinux by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estrogens conjugated synthetic

              estrogens conjugated synthetic decreases effects of fondaparinux by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estropipate

              estropipate decreases effects of fondaparinux by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • Factor X, human

              fondaparinux will decrease the level or effect of Factor X, human by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors.

            • heparin

              fondaparinux and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • levonorgestrel intrauterine

              levonorgestrel intrauterine, fondaparinux. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levonorgestrel oral

              levonorgestrel oral, fondaparinux. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levothyroxine

              levothyroxine increases effects of fondaparinux by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • liothyronine

              liothyronine increases effects of fondaparinux by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • mestranol

              mestranol decreases effects of fondaparinux by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • pentobarbital

              pentobarbital decreases effects of fondaparinux by increasing metabolism. Avoid or Use Alternate Drug.

            • phenindione

              fondaparinux and phenindione both increase anticoagulation. Avoid or Use Alternate Drug.

            • phenobarbital

              phenobarbital decreases effects of fondaparinux by increasing metabolism. Avoid or Use Alternate Drug.

            • primidone

              primidone decreases effects of fondaparinux by increasing metabolism. Avoid or Use Alternate Drug.

            • protamine

              fondaparinux and protamine both increase anticoagulation. Avoid or Use Alternate Drug.

            • quinine

              quinine increases effects of fondaparinux by unknown mechanism. Avoid or Use Alternate Drug.

            • rivaroxaban

              rivaroxaban, fondaparinux. Either increases effects of the other by anticoagulation. Contraindicated. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • roxithromycin

              roxithromycin increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

            • secobarbital

              secobarbital decreases effects of fondaparinux by increasing metabolism. Avoid or Use Alternate Drug.

            • sulfadiazine

              sulfadiazine increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfadiazine increases effects of fondaparinux by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfamethoxazole

              sulfamethoxazole increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfamethoxazole increases effects of fondaparinux by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfisoxazole

              sulfisoxazole increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfisoxazole increases effects of fondaparinux by plasma protein binding competition. Avoid or Use Alternate Drug.

            • thyroid desiccated

              thyroid desiccated increases effects of fondaparinux by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • tibolone

              tibolone increases effects of fondaparinux by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • ticlopidine

              fondaparinux, ticlopidine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • tirofiban

              fondaparinux, tirofiban. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • warfarin

              fondaparinux and warfarin both increase anticoagulation. Avoid or Use Alternate Drug.

            Monitor Closely (122)

            • aceclofenac

              fondaparinux and aceclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • acemetacin

              fondaparinux and acemetacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • agrimony

              fondaparinux and agrimony both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alfalfa

              fondaparinux and alfalfa both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alteplase

              fondaparinux and alteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • American ginseng

              fondaparinux and American ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • anamu

              fondaparinux and anamu both increase anticoagulation. Use Caution/Monitor.

            • aspirin

              fondaparinux and aspirin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin rectal

              fondaparinux and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin/citric acid/sodium bicarbonate

              fondaparinux and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • azapropazone

              azapropazone increases effects of fondaparinux by plasma protein binding competition. Use Caution/Monitor.

            • azathioprine

              azathioprine decreases effects of fondaparinux by unknown mechanism. Use Caution/Monitor.

            • azficel-T

              azficel-T, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

            • budesonide

              budesonide, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • capecitabine

              capecitabine increases effects of fondaparinux by unspecified interaction mechanism. Use Caution/Monitor.

            • caplacizumab

              caplacizumab, fondaparinux. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • carbamazepine

              carbamazepine decreases levels of fondaparinux by increasing metabolism. Use Caution/Monitor.

            • celecoxib

              fondaparinux and celecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • chitosan

              chitosan increases effects of fondaparinux by Other (see comment). Use Caution/Monitor. Comment: Chitosan can decrease GI absorption of vitamin K, enhancing anticoagulant effects.

            • choline magnesium trisalicylate

              fondaparinux and choline magnesium trisalicylate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cinnamon

              fondaparinux and cinnamon both increase anticoagulation. Modify Therapy/Monitor Closely.

            • citalopram

              citalopram increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

            • collagenase clostridium histolyticum

              fondaparinux increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).

            • conjugated estrogens, vaginal

              conjugated estrogens, vaginal decreases effects of fondaparinux by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Risk of thromboembolic disorders.

            • cordyceps

              fondaparinux and cordyceps both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cornsilk

              cornsilk decreases effects of fondaparinux by pharmacodynamic antagonism. Use Caution/Monitor. Cornsilk contains vitamin K; consume a consistent amount daily.

            • cortisone

              cortisone, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • cyclophosphamide

              cyclophosphamide increases effects of fondaparinux by unknown mechanism. Use Caution/Monitor. Due to potential thrombocytopenic effects of cyclophosphamide, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • danshen

              fondaparinux and danshen both increase anticoagulation. Use Caution/Monitor.

            • deferasirox

              deferasirox, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.

            • deflazacort

              deflazacort, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • devil's claw

              fondaparinux and devil's claw both increase anticoagulation. Use Caution/Monitor.

            • dexamethasone

              dexamethasone, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • dichlorphenamide

              dichlorphenamide and fondaparinux both decrease serum potassium. Use Caution/Monitor.

            • diclofenac

              fondaparinux and diclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • diflunisal

              fondaparinux and diflunisal both increase anticoagulation. Modify Therapy/Monitor Closely.

              diflunisal increases effects of fondaparinux by plasma protein binding competition. Use Caution/Monitor.

            • dong quai

              fondaparinux and dong quai both increase anticoagulation. Modify Therapy/Monitor Closely.

            • epoprostenol

              fondaparinux and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

            • escitalopram

              escitalopram increases effects of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • ethanol

              ethanol increases effects of fondaparinux by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

            • ethotoin

              fondaparinux increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • etodolac

              fondaparinux and etodolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenbufen

              fondaparinux and fenbufen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fennel

              fondaparinux and fennel both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenoprofen

              fondaparinux and fenoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • feverfew

              fondaparinux and feverfew both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fish oil

              fish oil, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of fondaparinux by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • fludrocortisone

              fludrocortisone, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • fluorouracil

              fluorouracil increases effects of fondaparinux by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of fluorouracil, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • fluoxetine

              fluoxetine increases effects of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • flurbiprofen

              fondaparinux and flurbiprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fluvoxamine

              fluvoxamine will increase the level or effect of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, which may increase bleeding risk when coadministered with anticoabulants

            • forskolin

              fondaparinux and forskolin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fosphenytoin

              fondaparinux increases levels of fosphenytoin by unknown mechanism. Use Caution/Monitor.

              fosphenytoin, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • garlic

              fondaparinux and garlic both increase anticoagulation. Modify Therapy/Monitor Closely.

            • gemcitabine

              gemcitabine increases effects of fondaparinux by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of gemcitabine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • ginger

              fondaparinux and ginger both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginkgo biloba

              fondaparinux and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

            • glucagon intranasal

              glucagon intranasal increases effects of fondaparinux by unknown mechanism. Use Caution/Monitor.

            • green tea

              green tea, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding, caution is advised.

            • hemin

              fondaparinux, hemin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Hemin degradation product (ie, hematin) may produce coagulopathy (eg, thrombocytopenia, platelet degranulation) and cause mild anticoagulant effects.

            • horse chestnut seed

              fondaparinux and horse chestnut seed both increase anticoagulation. Modify Therapy/Monitor Closely.

            • hydrocortisone

              hydrocortisone, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • ibrutinib

              ibrutinib will increase the level or effect of fondaparinux by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • ibuprofen

              fondaparinux and ibuprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ibuprofen IV

              fondaparinux and ibuprofen IV both increase anticoagulation. Modify Therapy/Monitor Closely.

            • icosapent

              icosapent, fondaparinux. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

            • indomethacin

              fondaparinux and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • iodine (radioactive)

              iodine (radioactive) decreases effects of fondaparinux by pharmacodynamic antagonism. Use Caution/Monitor.

            • ketoprofen

              fondaparinux and ketoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac

              fondaparinux and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac intranasal

              fondaparinux and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • lofepramine

              lofepramine increases levels of fondaparinux by decreasing metabolism. Use Caution/Monitor.

            • lornoxicam

              fondaparinux and lornoxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • meclofenamate

              fondaparinux and meclofenamate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • mefenamic acid

              fondaparinux and mefenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • melatonin

              melatonin increases effects of fondaparinux by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • meloxicam

              fondaparinux and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • methimazole

              methimazole decreases effects of fondaparinux by pharmacodynamic antagonism. Use Caution/Monitor.

            • methylprednisolone

              methylprednisolone, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • mistletoe

              fondaparinux increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nabumetone

              fondaparinux and nabumetone both increase anticoagulation. Modify Therapy/Monitor Closely.

            • naproxen

              fondaparinux and naproxen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • nettle

              fondaparinux increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • omega 3 fatty acids

              omega 3 fatty acids, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • oxaprozin

              fondaparinux and oxaprozin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • panax ginseng

              fondaparinux and panax ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • parecoxib

              fondaparinux and parecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • paroxetine

              paroxetine increases effects of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • pau d'arco

              fondaparinux and pau d'arco both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pegaspargase

              pegaspargase increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.

            • phenytoin

              fondaparinux increases levels of phenytoin by unknown mechanism. Use Caution/Monitor.

              phenytoin, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • phytoestrogens

              fondaparinux and phytoestrogens both increase anticoagulation. Modify Therapy/Monitor Closely.

            • piroxicam

              fondaparinux and piroxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • porfimer

              fondaparinux decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.

            • prasugrel

              fondaparinux, prasugrel. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced risk of hemorrhage.

            • prednisolone

              prednisolone, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • prednisone

              prednisone, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • propafenone

              propafenone increases effects of fondaparinux by decreasing metabolism. Use Caution/Monitor.

            • propylthiouracil

              propylthiouracil decreases effects of fondaparinux by pharmacodynamic antagonism. Use Caution/Monitor.

            • reishi

              fondaparinux and reishi both increase anticoagulation. Modify Therapy/Monitor Closely.

            • reteplase

              fondaparinux and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • rifabutin

              rifabutin decreases levels of fondaparinux by increasing metabolism. Use Caution/Monitor.

            • salicylates (non-asa)

              fondaparinux and salicylates (non-asa) both increase anticoagulation. Modify Therapy/Monitor Closely.

            • salsalate

              fondaparinux and salsalate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • saw palmetto

              saw palmetto increases toxicity of fondaparinux by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

            • sertraline

              sertraline increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

            • Siberian ginseng

              fondaparinux and Siberian ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulfasalazine

              fondaparinux and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulindac

              fondaparinux and sulindac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • tenecteplase

              fondaparinux and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ticagrelor

              ticagrelor, fondaparinux. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

            • tipranavir

              tipranavir increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Tipranavir has mild antiplatelet activity that may incr bleeding risk.

            • tolfenamic acid

              fondaparinux and tolfenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • tolmetin

              fondaparinux and tolmetin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • triclofos

              triclofos increases effects of fondaparinux by unspecified interaction mechanism. Use Caution/Monitor.

            • vorapaxar

              fondaparinux, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • vortioxetine

              vortioxetine and fondaparinux both increase anticoagulation. Use Caution/Monitor.

            • zanubrutinib

              fondaparinux, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            Minor (17)

            • acetaminophen

              acetaminophen increases effects of fondaparinux by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen IV

              acetaminophen IV increases effects of fondaparinux by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen rectal

              acetaminophen rectal increases effects of fondaparinux by unknown mechanism. Minor/Significance Unknown.

            • alprostadil intracavernous/urethral

              alprostadil intracavernous/urethral increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • ceftaroline

              ceftaroline increases effects of fondaparinux by Other (see comment). Minor/Significance Unknown. Comment: Cephalosporins with a methylthiotetrazole (MTT) side ring (eg, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity.

            • chlorella

              chlorella decreases effects of fondaparinux by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical, due to vitamin K content.

            • demeclocycline

              demeclocycline increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • dexmethylphenidate

              dexmethylphenidate increases effects of fondaparinux by decreasing metabolism. Minor/Significance Unknown.

            • doxycycline

              doxycycline increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • glyburide

              glyburide increases effects of fondaparinux by unspecified interaction mechanism. Minor/Significance Unknown.

            • mineral oil

              mineral oil decreases levels of fondaparinux by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • minocycline

              minocycline increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • oxytetracycline

              oxytetracycline increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • quinidine

              quinidine increases effects of fondaparinux by decreasing metabolism. Minor/Significance Unknown.

            • tetracycline

              tetracycline increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • verteporfin

              fondaparinux decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • vitamin E

              vitamin E, fondaparinux. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Vitamin E at RDA does not change INR in pts. on chronic warfarin therapy; megadoses (~10x RDA) may enhance anticoagulant effects in vitamin K deficient pts.

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            Adverse Effects

            >10%

            Anemia (1-20%)

            Fever (4-14%)

            Nausea (3-11%)

            1-10%

            Rash (7.5%)

            Dizziness (4%)

            Confusion (3%)

            Constipation (5-9%)

            Diarrhea (2-3%)

            Edema (9%)

            Headache (2-5%)

            Hypokalemia (1-4%)

            Hypotension (4%)

            Insomnia (4-5%)

            Purpura (4%)

            Thrombocytopenia (3%)

            Urinary retention (3%)

            Urinary tract infection (2-4%)

            Vomiting (1-6%)

            Postmarketing Reports

            Thrombocytopenia with thrombosis that manifested similarly to HIT

            Serious allergic reactions, including angioedema and anaphylactoid or anaphylactic reactions

            Spinal or epidural hematomas

            Hemorrhage

            Increase in bleeding risk with renal impairment

            Increase in bleeding risk with body weight <50 Kg

            Increase in aminotransferase levels

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            Warnings

            Black Box Warnings

            Epidural or spinal hematomas may occur in patients undergoing anticoagulation with low-molecular-weight heparins (LMWHs) or heparinoids who receive neuraxial (epidural or spinal) anesthesia or spinal puncture

            These hematomas may result in long-term or permanent paralysis

            Patients should be frequently monitored for signs and symptoms of neurologic impairment

            If neurologic compromise is noted, urgent treatment is necessary

            Physicians should weigh benefits against risk before embarking on neuraxial intervention in patients anticoagulated or scheduled to be anticoagulated for thromboprophylaxis

            Optimal timing between the administration of LMWHs and neuraxial procedures is not known

            Factors increasing risk of epidural or spinal hematomas

            • Indwelling epidural catheters
            • Concomitant use of other drugs that affect hemostasis (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], platelet inhibitors, other anticoagulants)
            • History of traumatic or repeated epidural or spinal punctures
            • History of spinal deformity or spinal surgery

            Contraindications

            Severe renal impairment (CrCl <30 mL/min)

            Body weight <50 kg (venous thromboembolism prophylaxis only)

            Active major bleeding

            Bacterial endocarditis

            Thrombocytopenia with antiplatelet antibody in presence of fondaparinux

            History of serious hypersensitivity reaction (eg, angioedema, anaphylactoid or anaphylactic reactions)

            Cautions

            Use with caution in the elderly (prolonged half-life in patients >75 years of age), peptic ulcer disease, bleeding disorder, recent stroke, recent surgery (brain, spinal cord, or eye), concurrent use of platelet inhibitors or anticoagulants, moderate renal impairment (CrCl 30-50 mL/min); may cause prolonged anticoagulation in patients with CrCl 30 to 50 mL/min

            Discontinue if platelets <100,000/μL

            Not for IM administration

            Therapy increases risk of hemorrhage in patients at risk for bleeding, including conditions such as congenital or acquired bleeding disorders, active ulcerative and angiodysplastic gastrointestinal disease, hemorrhagic stroke, uncontrolled arterial hypertension, diabetic retinopathy, or shortly after brain, spinal, or ophthalmological surgery; cases of elevated aPTT temporally associated with bleeding events have been reported following administration of drug (with or without concomitant administration of other anticoagulants); do not administer agents that enhance risk of hemorrhage unless essential for management of underlying condition, such as vitamin K antagonists for treatment of VTE; if co-administration is essential, closely monitor patients for signs and symptoms of bleeding

            Do not use interchangeably with heparin or LMWHs

            Thrombocytopenia with thrombosis reported with use; discontinue therapy if platelet count falls below 100,000/mm³

            Risk of spinal or epidural hematomas if spinal puncture occurs (see Black Box Warnings)

            Do not administer initial dose earlier than 6- 8 hours after surgery; administration earlier than 6 hours after surgery increases risk of major bleeding

            Increased risk of bleeding in patients <50 kg; dosage reduction recommended

            Not for administration as prophylactic for patients undergoing hip fracture, hip replacement, or knee replacement surgery and abdominal surgery

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            Pregnancy & Lactation

            Pregnancy

            Available data from published literature and postmarketing reports have not reported clear association with adverse developmental outcomes; fondaparinux sodium plasma concentrations obtained from four women treated during pregnancy and their newborn infants demonstrated low placental transfer of fondaparinux sodium; there are risks to mother associated with untreated venous thromboembolism in pregnancy and a risk of hemorrhage in the mother and fetus associated with use of anticoagulants

            Pregnancy confers an increased risk for thromboembolism that is higher for women with underlying thromboembolic disease and certain high-risk pregnancy conditions; published data describe that women with a previous history of venous thrombosis are at high risk for recurrence during pregnancy

            Fetal/neonatal adverse reactions

            • Drug has been demonstrated to cross placenta in humans; use of anticoagulants, may increase risk of bleeding in the fetus and neonate; monitor neonates for bleeding

            Labor or delivery

            • All patients receiving anticoagulants, including pregnant women, are at risk for bleeding; use during labor or delivery in women who are receiving neuraxial anesthesia may result in epidural or spinal hematomas; pregnant women receiving therapy should be carefully monitored for evidence of bleeding or unexpected changes in coagulation parameters; consideration for use of a shorter acting anticoagulant should be specifically addressed as delivery approaches

            Lactation

            There are no data on presence in human milk, or effects on milk production; limited clinical data during lactation preclude a clear determination of risk of therapy to an infant during lactation; therefore, developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Antithrombotic agent; inhibits factor Xa, which interrupts blood coagulation cascade and inhibits thrombin formation and thrombus development; generally does not increase prothrombin time (PT) or partial thromboplastin time (PTT)

            Absorption

            Bioavailability: 100%

            Peak plasma time: 2-3 hr

            Peak plasma concentration: 0.34-0.50 mg/L

            Distribution

            Protein bound: 94% (antithrombin III)

            Vd: 7-11 L

            Metabolism

            Not established

            Elimination

            Half-life: 17-21 hr

            Dialyzable: Yes

            Excretion: Urine

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Arixtra subcutaneous
            -
            2.5 mg/0.5 mL solution
            Arixtra subcutaneous
            -
            5 mg/0.4 mL solution
            Arixtra subcutaneous
            -
            7.5 mg/0.6 mL solution
            Arixtra subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            2.5 mg/0.5 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            5 mg/0.4 mL solution
            fondaparinux subcutaneous
            -
            7.5 mg/0.6 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution
            fondaparinux subcutaneous
            -
            10 mg/0.8 mL solution

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            fondaparinux subcutaneous

            FONDAPARINUX - INJECTION

            (FON-da-PAR-in-ux)

            COMMON BRAND NAME(S): Arixtra

            WARNING: People using this medication may bleed near the spinal cord after certain spinal procedures. Bleeding in this area can cause paralysis that lasts a long time or could become permanent. Talk with your doctor about the benefits and risks before any spinal procedure. Your doctor may direct you to stop this medication for a certain amount of time before and after the procedure. Carefully follow your doctor's directions.The risk of bleeding may be higher if you have a deformed spine, or have had spinal procedures/surgery before (such as epidural catheter placement, difficult epidural/spinal puncture), or are taking other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as warfarin/rivaroxaban, nonsteroidal anti-inflammatory drugs-NSAIDs such as ibuprofen). Tell your doctor right away if you notice symptoms such as back pain, leg numbness/tingling/weakness, loss of control of the bowels or bladder (incontinence).

            USES: Fondaparinux is used to treat serious blood clots in the legs and/or lungs. It is usually used with another "blood thinner" medication (warfarin). If untreated, blood clots can travel to the lungs, heart, or brain, causing serious (possibly fatal) breathing problems, heart attack, or stroke. This drug may also be used to prevent blood clots after certain surgeries with an increased risk of blood clots (such as hip fracture, abdominal, knee/hip replacement).Fondaparinux is known as a "blood thinner" (anticoagulant). It is a drug similar to heparin that works by blocking certain natural substances in the blood that cause clotting.

            HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using fondaparinux and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is given by injection under the skin of the stomach/abdomen as directed by your doctor, usually once daily. Do not inject into a muscle. The dosage and length of treatment are based on your medical condition and response to treatment. The dosage may also be based on your weight. Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time each day.If you are using this medication at home, learn all preparation and usage instructions from your health care professional and the product package. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Do not mix any other medication in the same injection. Before injecting each dose, clean the injection site with rubbing alcohol. Change the injection site each time to lessen injury under the skin. To minimize bruising, do not rub the injection site after a shot. Learn how to store and discard medical supplies safely.When treating a blood clot, another "blood thinner" (warfarin) is usually started within 3 days after you start using fondaparinux. Your doctor will direct you to use both of these medications until the warfarin is working well. Do not stop either of these medications until your doctor directs you to stop.To prevent blood clots due to surgery, your doctor may direct you to start using this medication after surgery (such as 6 to 8 hours after knee/hip replacement surgery) and continue for several days. Follow your doctor's directions closely. Starting this medication too soon after surgery may increase the risk of serious bleeding.This medication may also be given by injection into a vein by a health care professional, as directed by your doctor.

            SIDE EFFECTS: Pain, bruising, redness, and swelling at the injection site may occur. Headache, nausea, vomiting, swelling of the hands/feet, or fever may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: easy bleeding/bruising, dark urine, yellow eyes/skin.This medication may rarely cause serious bleeding. (See also Warning section.) Tell your doctor right away if you have any signs of serious bleeding, including: shortness of breath, coughing up blood, chest pain, cold/blue fingers or toes, unusual dizziness, fainting, fast/irregular heartbeat, joint/muscle pain, mental/mood changes (such as confusion), numbness/tingling, severe stomach/abdominal pain, bloody/black/tarry stools, red/pinkish urine, vomit that looks like coffee grounds.Get medical help right away if you have any very serious side effects, including: vision problems, weakness on one side of the body, trouble speaking, seizures, difficulty moving, severe/persistent headache.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: See also Warning section.Before using fondaparinux, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as dry natural rubber/latex in the needle cover on the prefilled syringe), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using fondaparinux, tell your doctor or pharmacist your medical history, especially of: infection in the heart (bacterial endocarditis), current serious bleeding (such as bleeding ulcer), low platelet count because of antiplatelet antibody, bleeding/blood problems (such as low blood count/platelets), a past blood-clotting problem because of heparin (heparin-induced thrombocytopenia), a certain eye problem (diabetic retinopathy), high blood pressure, kidney disease, seizures, stomach/intestinal problems (such as recent ulcers, colitis), stroke, recent spinal procedures or puncture, spine problems (such as spinal deformity), recent surgery (especially on the eye, brain, or spine), low body weight (less than 50 kilograms/110 pounds).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Limit alcohol while taking this drug because it may increase the risk of stomach bleeding.To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Older adults may be more sensitive to the side effects of this drug, especially bleeding.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. If you become pregnant or think you may be pregnant, tell your doctor right away.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: mifepristone, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ketorolac, "blood thinners" such as rivaroxaban).Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as ibuprofen, naproxen, aspirin) which can increase the risk of bleeding when used with fondaparinux. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: excessive bleeding and bruising.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as complete blood count, kidney function tests, tests to check for blood in the stool) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Each prefilled syringe can be used only once; discard any unused portion.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.