FRAGMIN 12,500 IU/0.5 ml PRE-FILLED SYRINGE SOLUTION FOR INJECTION

2. What you need to know before you use Fragmin

Do not use Fragmin if:

• you are allergic (hypersensitive) to dalteparin sodium, or any of the other ingredients of this medicine (listed in section 6), or to any other type of heparin (medicines that prevent blood clotting) different from dalteparin sodium or to products derived from pigs
• you have an acute gastroduodenal ulcer, cerebral hemorrhage, or other significant bleeding
• you have severe coagulation disorders
• you have a condition called acute or subacute bacterial endocarditis (inflammation of one of the heart membranes due to an infection)
• you have had an operation on the central nervous system, eyes, or ears, or if you have injuries to these organs or system
• you have a decrease in the number of platelets (cells present in the blood that are involved in blood clotting) and when a test for aggregation in the presence of dalteparin sodium is performed, the result is positive.

If you are being treated with Fragmin, you will not be able to have an epidural or spinal anesthetic.

Warnings and precautions:

Talk to your doctor, pharmacist, or nurse before starting treatment with Fragmin if:

• You are going to receive intramuscular injections of other medicines due to the risk of hematomas.
• You have a decrease in the number of platelets or defects in them. Your doctor may request specific tests to determine the cause of this problem.

• You have severe renal impairment (decreased kidney function) or severe hepatic impairment (decreased liver function).
• You have uncontrolled high blood pressure.
• You have retinal disorders (a part of the eye) due to diabetes or high blood pressure.
• You have recently undergone surgery or have a high risk of bleeding.
• You have had an acute myocardial infarction and are being treated with this medicine.
• You are at risk of having high levels of potassium in the blood due to some disease or due to taking certain medications. Your doctor may perform tests to measure potassium levels.
• You are undergoing epidural (in one of the membranes surrounding the brain and spinal cord) or spinal anesthesia (in the spinal cord), or a lumbar puncture, and you are being administered heparin for preventive purposes; very rarely, hematomas may occur in these areas. If you feel back pain, numbness, weakness in the lower limbs, or any disorder in the functioning of the intestine or bladder, inform your doctor immediately. You have a prosthetic heart valve, the preventive doses of Fragmin may not be sufficient to prevent valve thrombosis.
• You are receiving prolonged treatment for unstable coronary disease, such as prior to revascularization, your doctor may reduce your dose of Fragmin.
• You are allergic or suspect you have a possible allergy to latex (natural rubber) or if the needle cap of the pre-filled syringes of Fragmin is going to be handled by someone with a known or possible allergy to latex (natural rubber). The needle cap of the pre-filled syringes of Fragmin is made of latex (natural rubber) that can cause severe allergic reactions in people with a latex allergy (natural rubber).

Considering your condition and/or age, your doctor may perform tests to control anticoagulant activity and avoid the risk of bleeding or recurrence of thrombosis.

Fragmin should not be exchanged with other unfractionated heparins, low molecular weight heparins, or synthetic polysaccharides since their effect may not be the same.

Children and adolescents:

Fragmin is not used in newborns under 1 month of age.

Using Fragmin with other medicines:

Tell your doctor, pharmacist, or nurse if you are using, or have recently used, other medicines, including those obtained without a prescription.

Certain medicines may interact with Fragmin 12,500 IU/0.5 ml; in these cases, it may be convenient to change the dose or interrupt treatment with one of the medicines.

Thrombolytic treatment (which dissolves the clot) or some medicines that affect blood clotting may increase the risk of bleeding when combined with Fragmin:

• Aspirin (acetylsalicylic acid).
• Platelet inhibitors (used to decrease platelet aggregation and reduce the risk of blood clots).
• Thrombolytics (used to dissolve blood clots).
• Non-steroidal anti-inflammatory drugs (NSAIDs) (medicines used to treat inflammation).
• Vitamin K antagonists and other types of anticoagulants.
• Dextran (used in some artificial tears).

Pregnancy and breastfeeding:

Consult your doctor or pharmacist before taking or using any medicine, including Fragmin.

If you are pregnant, you should only use this medicine when it is clearly necessary, although Fragmin does not cross the placenta.

It is not recommended to use it with epidural anesthesia. Inform your doctor if you have an artificial heart valve.

If you are breastfeeding, inform your doctor; he will assess whether treatment with this medicine is suitable, as Fragmin passes into breast milk in small amounts.

Driving and using machines:

This medicine does not alter the ability to drive vehicles or use machinery.

Fragmin contains sodium

This medicine contains less than 23 mg (1 mmol) of sodium per pre-filled syringe; this is, essentially "sodium-free".

3. How to use Fragmin

Follow the instructions for administering Fragmin 12,500 IU/0.5 ml exactly as indicated by your doctor. Consult your doctor, pharmacist, or nurse if you have any doubts.

Remember to take or use your medicine.

Your doctor will indicate the dose, method of use, and duration of your treatment with Fragmin.

Fragmin is administered subcutaneously (by injection under the skin).

If you are going to be administered Fragmin 12,500 IU/0.5 ml to treat blood clots already present in the deep veins, treatment will start as soon as possible and will continue for at least 5 days or until the levels of prothrombin complex (factors involved in blood clotting) return to their adequate level. You may be administered one or two daily doses.

If you are administered a daily dose, it will be 200 IU per kilogram of body weight and per day, and it will be applied by injection under the skin. The daily dose will not exceed 18,000 IU.

If you are administered two daily doses, they will be 100 IU per kilogram of body weight and per day.

If necessary, your doctor will perform analytical controls.

Fragmin injections are normally administered by a healthcare professional, applied under the skin, in the anterior or posterior region of the abdomen, and alternately on the right and left sides.

Use in children and adolescents

Treatment of blood clots in the veins (symptomatic venous thromboembolism [VTE])

The recommended doses depend on the child's body weight and age group. The doctor will perform the calculation. The doctor will advise on the individualized dose of Fragmin according to these criteria. Do not change the dose or treatment schedule without consulting your doctor first.

This medicine is not suitable for use in the pediatric population because the pre-filled syringes do not allow the dose to be adjusted based on the child's body weight. It is recommended to use the 2,500 IU/ml solution for injection in 4 mL vials.

The effect of Fragmin will be controlled after the initial dose and subsequent dose adjustment through a blood test.

How to inject Fragmin

Fragmin is administered by subcutaneous injection (under the skin). This section of the leaflet explains how to administer Fragmin. You should follow these instructions only after being trained by your doctor. If you are not sure what to do, talk to your doctor immediately. You should inject (or administer) the dose of Fragmin at the times recommended by your doctor.

If it is necessary to dilute Fragmin before administration, this should be done by a healthcare professional. You should follow your doctor's instructions on how and when to inject the diluted medicine provided to you.

Please follow the steps explained below

Step 1: Preparing the syringe for injection will depend on the specific presentation of Fragmin being used.

The Needle-Trapsafety system is specially designed to help prevent accidents with needles after correct use of Fragmin. It consists of a plastic safety device attached to the label of the syringe. It is used to prevent accidental pricks after the correct injection of Fragmin. The needle protection device (Needle-Trap) consists of a plastic tab (clip) that is aligned in parallel with the needle, firmly attached to the label of the syringe cylinder.

The following actions are required to activate the safety system: Lift the syringe, hold the tip of the plastic needle blocker, and bend it away from the protector (see Figure 1).

Figure 1

Remove the gray rubber cap by pulling it outward (see Figure 2).

Figure 2

You will notice an air bubble in the syringe. This is expected and can be ignored. It is important not to press the plunger yet, as some of the medicine may be lost. The air bubble in the disposable syringes should not be expelled before injection, as this may cause loss of medicine and, therefore, a reduction in the dose.

Now you are ready to administer the injection. Continue with step 2.

Step 2: Choosing and preparing the subcutaneous injection site

Choose one of the recommended injection sites below (see shaded areas in Figure 3):

• A "U"-shaped area around the navel.
• Central area of the thighs.

Figure 3

• Use a different injection site each time you administer a dose.
• Do not administer the injection in areas where the skin is painful, bruised, red, or hard. Avoid areas with scars.
• If you or your child have psoriasis, do not administer the injection directly into any raised, thick, red, or scaly skin lesions ("psoriatic skin lesions").
• Wash and dry your hands.
• Clean the injection site with a new alcohol swab, using circular motions. Let the skin dry completely. Do not touch this area again before administering the injection.

Step 3: Adopting the correct posture

You or your child should be sitting or lying down for the administration of the subcutaneous injection. If you are going to self-inject the medicine, sit in a comfortable position where you can see your abdomen (see Figure 4).

Figure 4

Step 4:

With your thumb and index finger, lift a fold of skin with one hand. With the other hand, hold the syringe like a pencil. This will be the injection site.

Step 5:

If you are injecting Fragmin into an adult or yourself,hold the syringe over the skin fold, keeping it at a right angle (i.e., vertically, as in the diagram, and not at an angle). Insert the needle into the skin until it is completely inside (see Figure 5).

Figure 5

If you are going to inject Fragmin into a child,insert the needle into the skin to the end with a small, quick movement, at an angle of between 45° and 90° (see Figure 6).

Figure 6

Step 6:

Push the plunger all the way down at a slow and constant speed to administer the correct dose. Continue to pinch the skin fold while administering the injection, and then release the skin fold and remove the needle.

If there is any bleeding at the injection site, apply gentle pressure. Do not rub the injection site, as this may cause bruising.

Press the injection site with a cotton swab for 10 seconds. A slight bleeding may occur. Do not rub the injection site. You can place a bandage over the injection site.

Step 7: If your syringe has a Needle-Trapprotection device, activate it

Place the plastic blocker against a hard and stable surface and, with one hand, turn the syringe cylinder upward against the needle, forcing the needle toward the blocker until it clicks (see Figure 7).

Continue bending the needle until the syringe exceeds an angle of 45 degrees with the flat surface to permanently disable it (see Figure 8).

(see Figure 7) (see Figure 8)

Step 8:

Discard the syringe and needle in a sharps container. Keep your sharps container out of the reach of others. When the sharps container is almost full, discard it according to the instructions or talk to your doctor or nurse.

If you use more Fragmin than you should

If you have used more Fragmin than you should, consult your doctor or pharmacist immediately, go to the nearest hospital, or contact the Toxicology Information Service, phone 91 562 04 20.

If you forget to use Fragmin

Consult your doctor or pharmacist immediately.

Do not administer a double dose to make up for forgotten doses.

4. Possible side effects

Like all medicines, Fragmin can cause side effects, although not everybody gets them.

Common side effects (may affect up to 1 in 10 people):

• Pain and bruising at the injection site
• Reversible decrease in the number of platelets in the blood not mediated by immune mechanisms (type 1)
• Bleeding at any site, which has sometimes been fatal
• Temporary increase in liver enzymes

Rare side effects (may affect up to 1 in 1,000 people):

• Hair loss, skin cell death

Side effects of unknown frequency (cannot be estimated from the available data):

• Decrease in the number of platelets in the blood mediated by immune mechanisms induced by heparin (type 2)
• Severe allergic reactions
• Localized bleeding in the skull, abdomen, or other areas, sometimes fatal
• Rash
• Accumulation of blood in the skull or spine (epidural or spinal hematoma)
• Increased levels of potassium in the blood
• Osteoporosis (porous bones)

It is expected that the side effects in children will be the same as those in adults. However, there is little information available on the possible side effects with prolonged use in children.

Reporting of side effects:

If you experience any side effects, talk to your doctor or pharmacist, even if it is possible side effects not listed in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Fragmin

Keep out of sight and reach of children.

Do not store at a temperature above 25°C.

Do not use Fragmin after the expiration date (CAD) that appears on the packaging and outer carton. The expiration date is the last day of the indicated month.

Do not use Fragmin if it contains particles or appears discolored.

Medicines should not be disposed of via wastewater or household waste. Deposit the packaging and any unused medicines at the SIGRE collection point in your pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Packaging Contents and Additional Information

Composition of Fragmin 12,500 IU/0.5 ml:

The active ingredient of Fragmin 12,500 IU/0.5 ml is sodium dalteparin. Each milliliter of solution contains 25,000 IU (anti-Xa) of sodium dalteparin. The total content per vial is 12,500 IU (anti-Xa).

The other components are: water for injectable preparations, sodium hydroxide, and hydrochloric acid.

Appearance of Fragmin 12,500 IU/0.5 ml and Packaging Contents:

Pre-filled syringes with needle protection device: injectable solution for subcutaneous administration in pre-filled syringes with 12,500 IU (anti-Xa)/0.5 ml in packs of 5 pre-filled syringes.

Marketing Authorization Holder:

Pfizer, S.L.

Avda. de Europa 20-B.

Parque Empresarial La Moraleja

28108 Alcobendas (Madrid)

Manufacturer:

Pfizer Manufacturing Belgium NV

Rijksweg 12

2870 Puurs-Sint-Amands

Belgium

Additional Information for Healthcare Professionals/Users:

Fragmin 12,500 IU/0.5 ml is compatible with isotonic sodium chloride solutions (9 mg/ml) or glucose (50 mg/ml), both in glass bottles and plastic containers.

The compatibility of this medication with other products has not been investigated.

This leaflet was approved in June 2025

Detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es