Generic Medicine Info
Indications and Dosage
Prophylaxis of clotting in the extracorporeal circulation during haemodialysis
Adult: Dialysis session ≤4 hours: 2,000-2,500 international units given as bolus dose at the start of dialysis. Dialysis session >4 hours: 2,500 international units given as bolus dose at the start of dialysis, followed by continuous infusion of 750 international units/hour. Dose may be adjusted gradually in increments of 500 international units according to response. Dose may be given into the arterial side of the dialyser or via IV inj. The dialyser may be primed by flushing with 500-1,000 mL NaCl 0.9% containing 5,000 international units tinzaparin/L.

Prophylaxis of venous thromboembolism
Adult: Surgical patients at moderate risk: 3,500 international units given 2 hours before surgery, then once daily. Surgical patients at high risk (e.g. undergoing orthopaedic or cancer surgery): 4,500 international units given 12 hours before surgery, then once daily. Non-surgical patients immobilised due to acute medical illness (e.g. heart failure, respiratory failure, severe infections, active cancer): 3,500 international units once daily for patients at moderate risk; 4,500 international units once daily for patients at high risk. Continue doses for as long as the patient remains at risk of VTE.

Venous thromboembolism
Adult: For the treatment of DVT and/or pulmonary embolism: 175 international units/kg once daily for at least 6 days and until adequate oral anticoagulation is established. Extended treatment and prevention of recurrence in patients with active cancer: 175 international units/kg once daily for 6 months.
Active major haemorrhage or conditions predisposing to major haemorrhage, active bleeding from a local lesion (e.g. gastric and/or duodenal ulcer), haemophilia or major blood clotting disorders; current or history of immune-mediated heparin-induced thrombocytopenia (type II); acute or subacute septic endocarditis, uncontrolled severe hypertension, surgery involving the brain, spinal cord, or eye; haemorrhagic stroke, cerebral aneurysm, retinopathy. Locoregional anaesthesia in elective surgical procedures in patients receiving treatment doses of tinzaparin.
Special Precautions
Patient with prosthetic heart valve, risk factors for haemorrhage, history of thrombocytopenia (congenital or other drug-induced cases); history of gastrointestinal ulcer, risk factors for hyperkalaemia (e.g. diabetes mellitus, pre-existing metabolic acidosis, raised plasma K at pre-treatment, haematoma in body tissues), extreme body weight (<45 kg or >120 kg). Performing neuraxial anaesthesia or lumbar puncture in patients receiving prophylactic dose of tinzaparin. Not to be used interchangeably (unit for unit) with heparin or other LMWHs. Renal (CrCl <30 mL/min) and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Thrombocytopenia (including thrombocytopenia with thrombosis), asymptomatic thrombocytosis. Rarely, hyperkalaemia, skin necrosis, toxic skin eruption (e.g. Stevens-Johnson syndrome), angioedema, anaphylaxis.
Blood and lymphatic system disorders: Anaemia.
General disorders and administration site conditions: Inj site reactions (e.g. inj site haematoma, pain, pruritus, nodule erythema, and extravasation).
Immune system disorders: Hypersensitivity reactions.
Investigations: Hepatic enzyme increased.
Skin and subcutaneous tissue disorders: Dermatitis, rash, pruritus.
Vascular disorders: Haematoma, bruising, ecchymosis and purpura.
Potentially Fatal: Major haemorrhage.
Parenteral/SC: B
Monitoring Parameters
Monitor CBC with platelet count (at baseline then periodically thereafter); renal function, LFT; serum K levels (at baseline and periodically thereafter in patients at risk of hyperkalaemia); stool for occult blood. Closely monitor for signs or symptoms of bleeding. May consider monitoring anti-factor Xa levels in obese patients, patients with severe renal impairment, and pregnant women receiving therapeutic doses.
Symptoms: Haemorrhage, hypovolaemia. Management: Severe haemorrhage may be treated with protamine sulfate; 1 mg of protamine sulfate may inhibit the effects of approx 100 international units of tinzaparin. Actively manage any hypovolaemia. May use transfusion of fresh plasma if needed. Obtain plasma anti-factor Xa and anti-factor IIa activity during management.
Drug Interactions
Enhanced anticoagulant effect with other drugs affecting the coagulation system including agents that inhibit platelet function (e.g. aspirin, NSAIDs), thrombolytic agents, vitamin K antagonists, activated protein C, direct factor Xa and IIa inhibitors.
Description: Tinzaparin, a low molecular weight heparin (LMWH), exerts its antithrombotic activity by binding to antithrombin III, thus enhancing the inhibition of several activated coagulation factors, primarily factor Xa.
Duration: Detectable anti-factor Xa activity: Up to 24 hours.
Absorption: Absorbed after SC inj. Bioavailability: Approx 90% (SC). Time to peak plasma concentration: Within 4-6 hours.
Distribution: Volume of distribution: 4 L.
Metabolism: Partially metabolised via desulfation and depolymerisation.
Excretion: Via urine. Elimination half-life: Approx 90 minutes.
Store between 15-25°C.
MIMS Class
Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)
ATC Classification
B01AB10 - tinzaparin ; Belongs to the class of heparin group. Used in the treatment of thrombosis.
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Buckingham R (ed). Tinzaparin Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/12/2022.

Innohep 10,000 IU/mL (Leo Laboratories Limited). MHRA. https://products.mhra.gov.uk. Accessed 06/12/2022.

Innohep 20,000 IU/mL (Leo Laboratories Limited). MHRA. https://products.mhra.gov.uk. Accessed 13/02/2023.

Innohep Solution for Injection [S.C.] (Getz Bros. Philippines, Inc.). MIMS Philippines. http://www.mims.com/philippines. Accessed 13/02/2023.

Joint Formulary Committee. Tinzaparin Sodium. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/12/2022.

Tinzaparin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 15/02/2023.

Disclaimer: This information is independently developed by MIMS based on Tinzaparin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2023 MIMS. All rights reserved. Powered by MIMS.com
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