How does this medication work? What will it do for me?

Nadroparin belongs to the class of medications known as anticoagulants or antithrombotic agents. These medications reduce the clotting ability of the blood and can reduce the risk of harmful blood clots forming in blood vessels.

Nadroparin is used to prevent and treat deep vein thrombosis (DVT). This condition leads to the formation of blood clots in the blood vessels in the leg. These blood clots can sometimes travel to the lungs and block blood vessels there, resulting in a serious condition known as pulmonary embolism.

Nadroparin is used to prevent DVT and pulmonary embolism in people who are undergoing general surgery or orthopaedic surgery (e.g., hip or knee replacement). It is also used to prevent clotting in people undergoing hemodialysis. Nadroparin is also used to treat unstable angina and heart attack survivors.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Fraxiparine® Prefilled Syringes

Each mL of aqueous solution contains nadroparin calcium 9,500 anti-Xa IU. Single dose, disposable prefilled glass syringes of 0.3 mL (ungraduated green syringes), 2,850 anti-Xa IU; 0.4 mL (ungraduated orange syringes), 3,800 anti-Xa IU; 0.6 mL (graduated brown syringes), 5,700 anti-Xa IU; 0.8 mL (graduated green [teal] syringes), 7,600 anti-Xa IU; and 1 mL (graduated violet syringes), 9,500 anti-Xa IU.

Fraxiparine Forte® Prefilled Syringes

Each mL of aqueous solution contains nadroparin calcium 19,000 anti-Xa IU. Single dose, disposable prefilled glass syringes of 0.6 mL (graduated process blue syringes), 11,400 anti-Xa IU; 0.8 mL (graduated magenta syringes), 15,200 anti-Xa IU; and 1 mL (graduated reflex blue syringes), 19,000 anti-Xa IU.

How should I use this medication?

The recommended dose depends on the individual and the condition being treated. Nadroparin is injected under the skin (subcutaneously). Your doctor will recommend the dose that is most likely to prevent blood clots but that will not cause you to bleed easily. Your doctor or health care professional will show you how to inject the medication yourself. If you have any questions about how to use the medication, contact your doctor.

To use the medication:

  1. Before injecting nadroparin, wash your hands and the area of skin you will inject. Only use the injection if the solution appears clear and particle-free.
  2. Lie down and gently pinch a fold of skin (usually in the lower abdomen) between your finger and thumb. Choose alternate places on the lower abdomen for each injection (e.g., right side one day, left side the next day).
  3. Push the entire needle vertically into the skin and then press down on the syringe plunger to inject the medication. Make sure you are holding the skin the entire time you are injecting the needle and pressing down on the syringe plunger.
  4. After giving the injection, remove the needle from the skin. Use the safety shield to prevent the needle from injuring others.
  5. Use an alcohol swab to apply light pressure to the injection area for several seconds. Do not rub the site afterwards.
  6. Dispose of the syringe and needle safely (using a sharps container). Each syringe is for a single use only.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, contact your doctor or pharmacist. Do not inject a double dose to make up for a missed one.

Store this medication at room temperature and keep it out of the reach of children. Do not refrigerate or freeze the medication.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to nadroparin or to any of the ingredients of the medication
  • are allergic to other low-molecular-weight heparins or heparin
  • currently have or have previously had heparin-induced thrombocytopenia (decrease in the number of platelets), or test positive in a platelet-aggregation test while using nadroparin
  • have a history of bleeding in the brain
  • have a severe blood clotting disorder
  • have active bleeding, bleeding tendencies, or other conditions that could have an increased risk of bleeding
  • have acute infective endocarditis (bacterial infection of the heart)
  • have bleeding due to ulcers (e.g., active stomach or duodenal ulcers)
  • have eye problems due to diabetes or bleeding
  • have injuries to and have had operations on the brain, spinal cord, eyes, or ears
  • have severe kidney problems (unless you are using nadroparin to prevent clot formation during dialysis)
  • have uncontrolled high blood pressure
  • have received spinal anaesthesia and need continued daily treatment

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • discomfort or redness at injection site
  • hardening of skin or lump at injection site

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • bleeding
  • bleeding from gums when brushing teeth
  • bleeding from the injection site or surgical site
  • pain or bruising around the injection site

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a serious allergic reaction (e.g., swelling of face or throat, hives, or difficulty breathing or swallowing)
  • sudden change or loss of vision
  • sudden severe headache; loss of coordination; confusion; difficulty speaking or understanding speech; vision problems in one or both eyes; or weakness or numbness, especially on one side of the body

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Bleeding: The most serious risk associated with nadroparin is bleeding in any tissue or organ. It is extremely important to have regular blood tests (as prescribed by your doctor) to ensure that the correct level of blood thinning is occurring. If you have an increased risk of bleeding (for example, if you are over 65), your doctor should closely monitor your condition while you are taking this medication.

Body weight: The safety and efficacy of nadroparin for very heavy people (e.g., over 120 kg) and very light people (e.g., under 45 kg) have not been fully established. If your weight is very high or low, your doctor will monitor you closely while you are taking this medication.

Medical conditions: If you have coronary artery disease, high blood pressure, kidney problems, or liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Platelets: While you are using nadroparin, your doctor will also be monitoring your platelet count. If your platelet level drops very suddenly, you may have to stop this medication and switch to another type of medication. Make sure to tell your doctor if you have had any problems with low platelets or platelet defects in the past.

Potassium levels: Nadroparin may increase blood potassium levels, especially in people who are at risk for high potassium levels (e.g., people with diabetes or who take certain medications). Your doctor will monitor your potassium levels while you are using this medication.

Prosthetic heart valves: There have been reports of people with prosthetic heart valves who developed clots in their valves when treated with low-molecular-weight heparin medications such as nadroparin. Your doctor will need to monitor you closely while you are taking nadroparin.

Pregnancy: The medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if nadroparin passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between nadroparin and any of the following:

  • nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
  • oral anticoagulants (e.g., warfarin)
  • platelet inhibitors (e.g., ticlopidine, clopidogrel, eptifibatide)
  • thrombolytic agents (e.g., alteplase, streptokinase, urokinase)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.