WARNING: Tell your doctor you use this medicine before you have any type of spinal puncture or epidural/spinal anesthesia. Patients who have these procedures while they use this medicine are at risk for developing a blood clot on or near the spinal cord. This could result in long-term or permanent paralysis. The risk is increased in patients who have an indwelling epidural catheter, traumatic or repeated epidural or spinal puncture, a history of a deformed spine or spinal surgery, and in patients who use medicines that may affect blood clotting such as warfarin, aspirin, platelet inhibitors (eg, clopidogrel), and nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, naproxen). If you have a spinal puncture or epidural/spinal anesthesia while you use this medicine, tell your doctor immediately if you notice any signs or symptoms of nerve problems such as numbness or tingling, muscle weakness, or paralysis. Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking activated protein C (eg, drotecogin alfa); anticoagulants (eg, warfarin); direct factor Xa inhibitors (eg, rivaroxaban); direct thrombin inhibitors (eg, dabigatran); nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, ketorolac, naproxen); platelet inhibitors (eg, clopidogrel, ticlopidine), or salicylates (eg, aspirin). DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions, including low body weight or a history of kidney problems, liver problems, stomach or intestinal problems (eg, ulcers), stroke, vision problems caused by diabetes, a bleeding disorder, brain bleeding or blood conditions, severe or uncontrolled high blood pressure, allergies, pregnancy, or breast-feeding. Tell your doctor if you have recently had or are scheduled to have brain, spine, or eye surgery; an epidural catheter; or a spinal puncture. USE OF THIS MEDICINE IS NOT RECOMMENDED if you have severe kidney problems, inflammation of the heart due to a bacterial infection (eg, bacterial endocarditis), active major bleeding, severe bleeding problems, or if you have a low platelet count and the presence of antiplatelet antibodies. IF YOU WEIGH LESS THAN 110 POUNDS (50 KG), USE OF THE MEDICINE IS NOT RECOMMENDED if you are using this medicine to treat a blood clot in the lungs or legs, you will be having hip or knee replacement surgery or abdominal surgery, or you have had a hip fracture. Contact your doctor or pharmacist if you have any questions or concerns about using this medicine.