Formulary
Fondaparinux sodium: Indications, Dosing, Side Effects and Interactions
Fondaparinux sodium is a synthetic pentasaccharide that inhibits activated factor X.
MedNext Academy | 3 min read
Fondaparinux sodium: Indications, Dosing, Side Effects and Interactions
Fondaparinux sodium is a synthetic pentasaccharide that inhibits activated factor X.
Drug action
Fondaparinux sodium is a synthetic pentasaccharide that inhibits activated factor X.
Indications and dose
**Prophylaxis of venous thromboembolism in patients after undergoing major orthopaedic surgery of the hip or leg, or abdominal surgery**
- **Adult** (By Subcutaneous Injection): Initially 2.5 mg for 1 dose, dose to be given 6 hours after surgery, then 2.5 mg once daily.
**Prophylaxis of venous thromboembolism in medical patients immobilised because of acute illness**
- **Adult** (By Subcutaneous Injection): 2.5 mg once daily.
**Treatment of superficial-vein thrombosis**
- **Adult** (By Subcutaneous Injection): (body-weight 50 kg and above) 2.5 mg once daily for at least 30 days (max. 45 days if high risk of thromboembolic complications), treatment should be stopped 24 hours before surgery and restarted at least 6 hours post operatively.
**Treatment of unstable angina and non-ST-segment elevation myocardial infarction**
- **Adult** (By Subcutaneous Injection): 2.5 mg once daily for up to 8 days (or until hospital discharge if sooner), treatment should be stopped 24 hours before coronary artery bypass graft surgery (where possible) and restarted 48 hours post operatively.
**Treatment of deep-vein thrombosis and pulmonary embolism**
- **Adult** (By Subcutaneous Injection): (body-weight 101 kg and above) 10 mg once daily for at least 5 days and until adequate oral anticoagulation established.
Cautions
Active gastro-intestinal ulcer disease; bleeding disorders; brain surgery; elderly patients; low body-weight; ophthalmic surgery; recent intracranial haemorrhage; risk of catheter thrombus during percutaneous coronary intervention; spinal or epidural anaesthesia (risk of spinal haematoma-avoid if using treatment doses for venous thromboembolism); spinal surgery
Contraindications
Active bleeding; bacterial endocarditis
Side effects
Common or very common Anaemia; haemorrhage Uncommon Chest pain; coagulation disorder; dyspnoea; fever; hepatic function abnormal; nausea; oedema; platelet abnormalities; skin reactions; thrombocytopenia; vomiting; wound secretion Rare or very rare Anxiety; confusion; constipation; cough; diarrhoea; dizziness; drowsiness; fatigue; gastritis; gastrointestinal discomfort; genital oedema; headache; hyperbilirubinaemia; hypersensitivity; hypokalaemia; hypotension; leg pain; post procedural infection; syncope; vasodilation; vertigo
Interactions
**Other interactions (3):**
- In clinical studies performed with fondaparinux, oral anticoagulants (warfarin) did not interact with the pharmacokinetics of fondaparinux; at the 10 mg dose used in the interaction studies,...
- Platelet inhibitors (acetylsalicylic acid), NSAIDs (piroxicam) and digoxin did not interact with the pharmacokinetics of fondaparinux.
- At the 10 mg dose used in the interaction studies, fondaparinux did not influence the bleeding time under acetylsalicylic acid or piroxicam treatment, nor the pharmacokinetics of digoxin at steady...
Pregnancy
Manufacturer advises avoid unless potential benefit outweighs possible risk-no information available.
Breast feeding
Present in milk in animal studies-manufacturer advises avoid.
Hepatic impairment
When used for Prophylaxis of venous thromboembolism or Treatment of unstable angina and non-ST-segment elevation myocardial infarction or Treatment of ST-segment elevation myocardial infarction or Treatment of deep-vein thrombosis and pulmonary embolism: Caution in severe impairment (increased risk of bleeding). M When used for Treatment of superficial-vein thrombosis: Avoid in severe impairment (no information available). M
Renal impairment
Increased risk of bleeding in renal impairment. When used for Prophylaxis of venous thromboembolism or Treatment of superficial-vein thrombosis or Treatment of unstable angina and non-ST-segment elevation myocardial infarction or Treatment of ST-segment elevation myocardial infarction: Avoid if creatinine clearance less than 20 mL/minute. M When used for Treatment of deep-vein thrombosis and pulmonary embolism: Use with caution if creatinine clearance 30-50 mL/minute; avoid if creatinine clearance less than 30 mL/minute. M Dose adjustments See Prescribing in renal impairment . When used for Prophylaxis of venous thromboembolism or Treatment of superficial-vein thrombosis: Reduce dose to 1.5 mg once daily if creatinine clearance 20-50 mL/minute. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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