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enoxaparin (Subcutaneous route, Injection route)

Pronunciation

ee-nox-a-PAR-in

Injection route(Solution)

Epidural or spinal hematomas, which may result in long-term or permanent paralysis, may occur in patients who are anticoagulated with low molecular weight heparins or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. Factors that can increase the risk of developing these hematomas include: use of indwelling epidural catheters, concomitant use of drugs affecting hemostasis such as NSAIDs, platelet inhibitors, or other anticoagulants, or history of traumatic or repeated epidural or spinal puncture, spinal deformity, or spinal surgery. Optimal timing between the administration of enoxaparin sodium and neuraxial procedures is not known. Monitor patients frequently for neurological impairment. If neurological compromise is noted, urgent treatment is necessary. Consider risks/benefits before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis .

Commonly used brand name(s)

In the U.S.

  • Lovenox

Available Dosage Forms:

  • Solution
  • Injectable

Therapeutic Class: Anticoagulant

Pharmacologic Class: Low Molecular Weight Heparin

Uses For enoxaparin

Enoxaparin is used to prevent deep venous thrombosis, a condition in which harmful blood clots form in the blood vessels of the legs. These blood clots can travel to the lungs and can become lodged in the blood vessels of the lungs, causing a condition called pulmonary embolism. enoxaparin is used for several days after hip or knee replacement surgery, and in some cases following abdominal surgery, while you are unable to walk. It is during this time that blood clots are most likely to form. Enoxaparin is also used if you are unable to get out of bed because of a serious illness. In addition, enoxaparin is used to prevent blood clots from forming in the arteries of the heart during certain types of chest pain and heart attacks.

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Enoxaparin is used together with warfarin to treat acute deep vein thrombosis with or without pulmonary embolism. It is also used to treat certain types of acute heart attacks.

enoxaparin is available only with your doctor's prescription.

Before Using enoxaparin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For enoxaparin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to enoxaparin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of enoxaparin in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of enoxaparin in the elderly. However, elderly patients are more likely to have bleeding problems and age-related kidney disease, which may require an adjustment in the dose for patients receiving enoxaparin, especially those who weigh less than 45 kilograms (99 lb).

Pregnancy

Pregnancy Category Explanation
All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking enoxaparin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using enoxaparin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abciximab
  • Aceclofenac
  • Acemetacin
  • Acenocoumarol
  • Alipogene Tiparvovec
  • Alteplase, Recombinant
  • Amtolmetin Guacil
  • Anistreplase
  • Antithrombin, Recombinant
  • Apixaban
  • Argatroban
  • Aspirin
  • Bivalirudin
  • Bromfenac
  • Bufexamac
  • Celecoxib
  • Choline Salicylate
  • Citalopram
  • Clonixin
  • Clopidogrel
  • Collagenase, Clostridium histolyticum
  • Dabigatran Etexilate
  • Dalteparin
  • Danaparoid
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Drotrecogin Alfa
  • Eptifibatide
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenofibrate
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Heparin
  • Ibuprofen
  • Ibuprofen Lysine
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lepirudin
  • Levomilnacipran
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Paroxetine
  • Pentosan Polysulfate Sodium
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pranoprofen
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Reteplase, Recombinant
  • Rivaroxaban
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sodium Salicylate
  • Streptokinase
  • Sulindac
  • Tenecteplase
  • Tenoxicam
  • Tiaprofenic Acid
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Tolfenamic Acid
  • Tolmetin
  • Urokinase
  • Valdecoxib
  • Vorapaxar
  • Vortioxetine
  • Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of enoxaparin. Make sure you tell your doctor if you have any other medical problems, especially:

  • Blood disease or bleeding problems or
  • Blood vessel problems or
  • Catheter insertion in the spine or
  • Diabetic retinopathy (eye problem) or
  • Heart infection or
  • Heart valves, prosthetic or
  • Hypertension (high blood pressure), uncontrolled or
  • Septic shock or
  • Stomach or intestinal ulcer or bleeding, active or
  • Stroke, recent or history of or
  • Surgery (e.g., eye, brain, or spine), recent or history of or
  • Thrombocytopenia, heparin-induced, or history of or
  • Threatened miscarriage
  • Weight of less than 99 pounds in women or 126 pounds in men—Use with caution. The risk of bleeding may be increased.
  • Major bleeding, active or
  • Thrombocytopenia (low platelet count in the blood)—Should not use in patients with these conditions.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal from the body.

Proper Use of enoxaparin

A nurse or other trained health professional will usually give you enoxaparin in the hospital. enoxaparin is given as a shot under your skin.

If you are using enoxaparin at home, your doctor will teach you how to inject yourself with the medicine. Be sure to follow the directions carefully. Check with your doctor if you have any problems using the medicine.

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. This will help prevent skin problems from the injections.

If the medicine in the prefilled syringe has changed color, or if you see particles in it, do not use it.

Dosing

The dose of enoxaparin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of enoxaparin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form:
    • For prevention of blood clots after unstable angina (chest pain) or non–Q-wave myocardial infarction (a type of heart attack):
      • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 1 milligram (mg) per kilogram (kg) of body weight injected under the skin every twelve hours for 2 to 8 days. Aspirin 100 to 325 mg orally once a day may also be given. However, the dose is 1 mg per kg once a day if you have a poorly performing kidney.
      • Children—Use and dose must be determined by your doctor.
    • For prevention of deep venous thrombosis (abdominal surgery):
      • Adults—40 milligrams (mg) injected under the skin once a day for 7 to 10 days. The first dose should be given 2 hours before the surgery. However, the dose is 30 mg once a day if you have a poorly performing kidney.
      • Children—Use and dose must be determined by your doctor.
    • For prevention of deep venous thrombosis (hip or knee replacement surgery):
      • Adults—30 milligrams (mg) injected under the skin every twelve hours for 7 to 10 days. Alternatively, for hip replacement surgery, the dose may be 40 mg injected under the skin once a day for three weeks. The dose is 30 mg once a day if you have a poorly performing kidney.
      • Children—Use and dose must be determined by your doctor.
    • For prevention of deep venous thrombosis (in patients with a serious illness who cannot get out of bed):
      • Adults—40 milligrams (mg) injected under the skin once a day for 6 to 11 days. The dose is 30 mg once a day if you have a poorly performing kidney.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of acute deep vein thrombosis with or without pulmonary embolism:
      • Adults—Dose is based on body weight and must be determined by your doctor. However, the dose is usually 1 milligram (mg) per kilogram (kg) of body weight every 12 hours injected under the skin for 7 days. The dose is 1 mg per kg once a day if you have a poorly performing kidney.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of certain type of acute heart attack
      • Adults—Dose is based on body weight and must be determined by your doctor. However, the dose is usually 30 milligrams (mg) injected into your vein and 1 milligram (mg) per kilogram (kg) of body weight injected under the skin followed by 1 mg per kg every 12 hours injected under the skin for 8 days. Aspirin 75 to 325 mg orally once a day may also be given.
      • Older adults—Dose is based on body weight and must be determined by your doctor. However, the starting dose is 0.75 milligram (mg) per kilogram (kg) of body weight injected under the skin every 12 hours for 8 days. Aspirin 75 to 325 mg orally once a day may also be given.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of enoxaparin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

If you were given a bottle of medicine to use with your syringes, you must use the medicine within 28 days after the first shot. Throw away the unused medicine in the bottle after 28 days.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Precautions While Using enoxaparin

It is very important that your doctor check your progress at regular visits to make sure enoxaparin is working properly. Blood tests will be needed to check for unwanted effects. Be sure to keep all appointments.

You may bleed or bruise more easily while you are using enoxaparin. Stay away from rough sports or other situations where you could be bruised, cut , or injured. Be careful when using sharp objects, including razors and fingernail clippers. Avoid nose picking and forceful nose blowing.

Make sure any doctor or dentist who treats you knows that you are using enoxaparin. You may need to stop using enoxaparin several days before having surgery or medical tests.

Enoxaparin may cause bleeding problems. This risk is higher if you have a catheter in your back for pain medicine or anesthesia (sometimes called an "epidural"), or if you have kidney problems. The risk of bleeding increases if your kidney problems get worse. Check with your doctor right away if you have any unusual bleeding or bruising; black, tarry stools; bleeding gums; blood in the urine or stools; tingling, numbness, or weakness of the lower legs; or pinpoint red spots on your skin.

enoxaparin may increase your chance of bleeding or bruising. Check with your doctor right away if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin. Avoid picking your nose. If you need to blow your nose, blow it gently.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Make sure your doctor knows if you have received enoxaparin or heparin before and had a reaction called thrombocytopenia (low platelet count in the blood), or if new blood clots formed while you were receiving the medicine.

Tell your doctor if you have recently given birth, fallen or suffered a blow to the body or head, or had medical or dental surgery. These events may increase the risk of serious bleeding while you are taking enoxaparin.

Lovenox® multiple-dose vials contain benzyl alcohol as a preservative. Tell your doctor right away if you are pregnant or have had an allergic reaction to benzyl alcohol.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

enoxaparin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Bleeding gums
  • coughing up blood
  • difficulty with breathing or swallowing
  • dizziness
  • headache
  • increased menstrual flow or vaginal bleeding
  • nosebleeds
  • paralysis
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • shortness of breath
Less common
  • Bruising
  • chest discomfort
  • collection of blood under the skin
  • confusion
  • continuing bleeding or oozing from the nose and/or mouth, or surgical wound
  • convulsions (seizures)
  • fever
  • irritability
  • lightheadedness
  • lower back pain
  • pain or burning while urinating
  • swelling of the hands or feet
  • tightness in the chest
  • uncontrolled bleeding at the site of injection
  • vomiting of blood or material that looks like coffee grounds
  • wheezing
Rare
  • Back pain
  • burning, pricking, tickling, or tingling sensation
  • chest pain
  • chills
  • cough
  • decreased urine output
  • dilated neck veins
  • dizziness or lightheadedness when getting up suddenly from a lying or sitting position
  • extreme fatigue
  • fainting
  • fast or irregular heartbeat
  • general feeling of discomfort or illness
  • irregular breathing
  • leg weakness
  • problems with bowel or bladder function
  • skin rash or hives
  • sneezing
  • sore throat
  • sudden fainting
  • swelling of the face, fingers, feet, genitals, mouth, or tongue
  • thickening of the bronchial secretions
  • troubled breathing
  • weight gain
Incidence not known
  • Abdominal or stomach pain
  • deep, dark purple bruise
  • hives or welts
  • irregular heartbeat
  • itching, pain, redness, or swelling
  • large, flat, blue, or purplish patches in the skin
  • nausea or vomiting
  • nervousness
  • numbness or tingling in the hands, feet, or lips
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the skin
  • skin rash
  • unusual tiredness or weakness
  • weakness or heaviness of the legs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Diarrhea
  • irritation, pain, or redness at the place of injection

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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