When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to tinzaparin, heparin, sulfites, benzyl alcohol, or any product made from pork. You should not use this medicine if you have an active major bleeding or a history of serious bleeding caused by heparin.

How to Use This Medicine:
Injectable

• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot under your skin, usually around your abdomen or stomach.
• A nurse or other health provider will give you this medicine. It may also be given by a home health caregiver.
• You may be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.
• You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.
• Use a new needle and syringe each time you inject your medicine.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using clopidogrel (Plavix®), dipyridamole (Aggrenox®, Persantine®), streptokinase (Streptase®), sulfinpyrazone (Anturane®), ticlopidine (Ticlid®), dextran, any other blood thinners (such as warfarin, Coumadin®), or pain or arthritis medicine (such as aspirin, diclofenac, etodolac, ibuprofen, indomethacin, ketorolac, Advil®, Aleve®, Daypro®, Dolobid®, Feldene®, Indocin®, Motrin®, Orudis®, Relafen®, Toradol®, or Voltaren®).

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have bleeding problems, kidney disease, liver disease, severe and uncontrolled high blood pressure, stomach ulcer or bleeding, diabetes-related eye disease, any problems with your heart (such as an infection), a history of stroke or spinal injury, or if you have recently had brain, spine, or eye surgery.
• This medicine may cause bleeding or bruising. This risk is higher if you have a catheter in your back for pain medicine or anesthetics. This is sometimes called an "epidural". Discuss this with your doctor if you are concerned.
• This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash; itching; swelling of the face, tongue, and throat; trouble breathing; or chest pain after you receive this medicine.
• You may bleed and bruise more easily while you are using this medicine. Be extra careful to avoid injuries until the effects of the medicine have worn off. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers. Avoid picking your nose. If you need to blow your nose, blow it gently.
• Watch for any bleeding from open areas such as around the injection site. Also check for blood in your urine or stool. If you have any bleeding or injuries, tell your doctor right away.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Bloody or black, tarry stools.
• Change in how much or how often you urinate, or painful urination.
• Chest pain, shortness of breath, or coughing up blood.
• Lightheadedness or fainting.
• Painful or prolonged erection of the penis.
• Red or dark brown urine.
• Sudden back pain, weakness, numbness in the legs or lower body.
• Sudden or severe pain.
• Unexplained nosebleeds.
• Unusual bleeding or bruising.
• Vomiting of blood or material that looks like coffee grounds.

If you notice these less serious side effects, talk with your doctor:

• Redness, pain, or bruising where the shot was given.
• Unusual vaginal bleeding.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088