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enoxaparin

Pronunciation

Generic Name: enoxaparin (ee nox AP a rin)
Brand Name: Lovenox, Lovenox HP, Clexane, Clexane Forte

What is enoxaparin?

Enoxaparin is an anticoagulant that helps prevent the formation of blood clots.

Enoxaparin is used to treat or prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery, or in people who are bed-ridden due to a prolonged illness.

Enoxaparin is also used to prevent blood vessel complications in people with certain types of angina (chest pain) or heart attack.

Enoxaparin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about enoxaparin?

You should not use this medicine if you have active bleeding, or a low level of platelets in your blood after testing positive for a certain antibody while using enoxaparin.

Enoxaparin can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, a history of spinal surgery or repeated spinal taps, or if you are using other drugs that can affect blood clotting, including blood thinners or NSAIDs (ibuprofen, Advil, Aleve, and others). This type of blood clot can lead to long-term or permanent paralysis.

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Get emergency medical help if you have symptoms of a spinal cord blood clot such as back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

What should I discuss with my healthcare provider before using enoxaparin?

You should not use this medicine if you are allergic to enoxaparin, heparin, benzyl alcohol, or pork products, or if you have:

  • active or uncontrolled bleeding; or

  • a low level of platelets in your blood after testing positive for a certain antibody while using enoxaparin.

Enoxaparin may cause you to bleed more easily, especially if you have:

  • a bleeding disorder that is inherited or caused by disease;

  • hemorrhagic stroke;

  • an infection of the lining of your heart (also called bacterial endocarditis);

  • stomach or intestinal bleeding or ulcer; or

  • recent brain, spine, or eye surgery.

Enoxaparin can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term or permanent paralysis, and may be more likely to occur if:

  • you have a spinal cord injury;

  • you have a spinal catheter in place or if a catheter has been recently removed;

  • you have a history of spinal surgery or repeated spinal taps;

  • you have recently had a spinal tap or epidural anesthesia;

  • you are taking an NSAID (nonsteroidal anti-inflammatory drug)--ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, indomethacin, meloxicam, and others; or

  • you are using a blood thinner (warfarin, Coumadin) or other medicines to treat or prevent blood clots.

To make sure enoxaparin is safe for you, tell your doctor if you have:

  • kidney or liver disease;

  • uncontrolled high blood pressure;

  • eye problems caused by diabetes;

  • recent stomach ulcer; or

  • if you have ever had low blood platelets after receiving heparin.

FDA pregnancy category B. Enoxaparin is not expected to harm an unborn baby. However, some forms of this medication contain a preservative that may be harmful to a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment. If you use this medication during pregnancy, make sure your doctor knows if you have a mechanical heart valve.

It is not known whether enoxaparin passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I use enoxaparin?

Enoxaparin is usually given every day until your bleeding condition improves. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Enoxaparin is injected under the skin or into a vein through an IV. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

You should be sitting or lying down during the injection. Do not inject enoxaparin into a muscle.

Use a different place on your stomach each time you give an injection under the skin. Your care provider will show you the best places on your body to inject the medication. Do not inject into the same place two times in a row.

Prepare your dose in a syringe only when you are ready to give yourself an injection. Do not mix enoxaparin with other medications in the same IV. Do not use enoxaparin if it has changed colors or has particles in it. Call your pharmacist for new medication.

Use a disposable needle only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Tell any doctor who treats you that you are using enoxaparin. If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using this medication.

While using enoxaparin, your blood and your stool (bowel movement) may need to be tested often. Your nerve and muscle function may also need to be tested.

Store enoxaparin vials (bottles) at room temperature away from moisture and heat. Once you have used a vial for the first time, the medicine will keep at room temperature for up to 28 days. Throw away the vial after 28 days have passed since you first used the vial, even if there is still medicine left in it.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose may cause excessive bleeding.

What should I avoid while using enoxaparin?

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Enoxaparin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; itching or burning skin; difficulty breathing; swelling of your face, lips, tongue, or throat.

Also seek emergency medical attention if you have symptoms of a spinal blood clot: back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Call your doctor at once if you have:

  • unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;

  • easy bruising, purple or red pinpoint spots under your skin;

  • pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

  • black or bloody stools, coughing up blood or vomit that looks like coffee grounds;

  • sudden weakness, severe headache, confusion, or problems with speech, vision, or balance; or

  • trouble breathing.

Common side effects may include:

  • nausea, diarrhea;

  • fever;

  • swelling in your hands or feet; or

  • mild pain, irritation, redness, or swelling where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Enoxaparin dosing information

Usual Adult Dose for Deep Vein Thrombosis -- Prophylaxis:

40 mg subcutaneously once a day. The usual duration of administration is 6 to 11 days; up to 14 days administration has been well tolerated in clinical trials.

In morbidly obese patients (BMI of 40 kg/m2 or greater), increasing the prophylactic dose by 30% may be appropriate.

Usual Adult Dose for Deep Vein Thrombosis:

Outpatient: 1 mg/kg subcutaneously every 12 hours
Inpatient: 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg subcutaneously once a day at the same time every day. In both outpatient and inpatient treatments, warfarin sodium therapy should be initiated on the same day of starting enoxaparin. Enoxaparin should be continued for a minimum of 5 days and until a therapeutic oral anticoagulant effect has been achieved (INR 2.0 to 3.0). The average duration of administration is 7 days; up to 17 days of has been well tolerated in controlled clinical trials.

Obesity: Use actual body weight to calculate dose; dose capping not recommended; use of twice daily dosing preferred.

Usual Adult Dose for Myocardial Infarction:

Unstable angina and non Q wave myocardial infarction:
1 mg/kg subcutaneously every 12 hours in conjunction with oral aspirin therapy (100 to 325 mg once daily).
Obesity: Use actual body weight to calculate dose; dose capping not recommended.
Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.

Acute ST segment elevation myocardial infarction:
A single 30 mg intravenous bolus plus a 1 mg/kg subcutaneous dose followed by 1 mg/kg subcutaneously every 12 hours (maximum 100 mg for the first two doses only, followed by 1 mg/kg for the remaining doses).
Obesity: Use weight based dosing; a maximum dose of 100 mg is recommended for the first 2 doses.

When given in conjunction with a thrombolytic, enoxaparin should be given between 15 minutes prior and 30 minutes after the start of fibrinolytic treatment. All patients should be given oral aspirin therapy (75 to 325 mg once daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. In patients receiving thrombolytics, initiate enoxaparin dosing between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients managed by PCI, if the last subcutaneous dose of enoxaparin was less than 8 hours before balloon inflation, no additional dosing is required. If the last subcutaneous dose was given more than 8 hours before balloon inflation, an intravenous bolus of 0.3 mg/kg should be given.

Usual Adult Dose for Angina Pectoris:

Unstable angina and non Q wave myocardial infarction:
1 mg/kg subcutaneously every 12 hours in conjunction with oral aspirin therapy (100 to 325 mg once daily).
Obesity: Use actual body weight to calculate dose; dose capping not recommended.
Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.

Acute ST segment elevation myocardial infarction:
A single 30 mg intravenous bolus plus a 1 mg/kg subcutaneous dose followed by 1 mg/kg subcutaneously every 12 hours (maximum 100 mg for the first two doses only, followed by 1 mg/kg for the remaining doses).
Obesity: Use weight based dosing; a maximum dose of 100 mg is recommended for the first 2 doses.

When given in conjunction with a thrombolytic, enoxaparin should be given between 15 minutes prior and 30 minutes after the start of fibrinolytic treatment. All patients should be given oral aspirin therapy (75 to 325 mg once daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. In patients receiving thrombolytics, initiate enoxaparin dosing between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients managed by PCI, if the last subcutaneous dose of enoxaparin was less than 8 hours before balloon inflation, no additional dosing is required. If the last subcutaneous dose was given more than 8 hours before balloon inflation, an intravenous bolus of 0.3 mg/kg should be given.

Usual Adult Dose for Acute Coronary Syndrome:

Unstable angina and non Q wave myocardial infarction:
1 mg/kg subcutaneously every 12 hours in conjunction with oral aspirin therapy (100 to 325 mg once daily).
Obesity: Use actual body weight to calculate dose; dose capping not recommended.
Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.

Acute ST segment elevation myocardial infarction:
A single 30 mg intravenous bolus plus a 1 mg/kg subcutaneous dose followed by 1 mg/kg subcutaneously every 12 hours (maximum 100 mg for the first two doses only, followed by 1 mg/kg for the remaining doses).
Obesity: Use weight based dosing; a maximum dose of 100 mg is recommended for the first 2 doses.

When given in conjunction with a thrombolytic, enoxaparin should be given between 15 minutes prior and 30 minutes after the start of fibrinolytic treatment. All patients should be given oral aspirin therapy (75 to 325 mg once daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. In patients receiving thrombolytics, initiate enoxaparin dosing between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients managed by PCI, if the last subcutaneous dose of enoxaparin was less than 8 hours before balloon inflation, no additional dosing is required. If the last subcutaneous dose was given more than 8 hours before balloon inflation, an intravenous bolus of 0.3 mg/kg should be given.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery:

30 mg subcutaneously every 12 hours. Provided that hemostasis has been established, the initial dose should be given 12 to 24 hours after surgery. For hip replacement surgery, a dose of 40 mg subcutaneously once a day given initially 12 hours prior to surgery may be considered. Following the initial phase of thromboprophylaxis in hip replacement surgery patients, continued prophylaxis with 40 mg subcutaneously once a day for 3 weeks is recommended. The usual duration of administration is 7 to 10 days; up to 14 days administration has been well tolerated in clinical trials.

In morbidly obese patients (BMI of 40 kg/m2 or greater), increasing the prophylactic dose by 30% may be appropriate.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery:

30 mg subcutaneously every 12 hours. Provided that hemostasis has been established, the initial dose should be given 12 to 24 hours after surgery. For hip replacement surgery, a dose of 40 mg subcutaneously once a day given initially 12 hours prior to surgery may be considered. Following the initial phase of thromboprophylaxis in hip replacement surgery patients, continued prophylaxis with 40 mg subcutaneously once a day for 3 weeks is recommended. The usual duration of administration is 7 to 10 days; up to 14 days administration has been well tolerated in clinical trials.

In morbidly obese patients (BMI of 40 kg/m2 or greater), increasing the prophylactic dose by 30% may be appropriate.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Abdominal Surgery:

40 mg subcutaneously once a day with the initial dose given 2 hours prior to surgery. The usual duration of administration is 7 to 10 days; up to 12 days administration has been well tolerated in clinical trials.

Bariatric surgery:Roux en Y gastric bypass: Appropriate dosing strategies have not been clearly defined.
BMI less than or equal to 50 kg/m2: 40 mg subcutaneously every 12 hours
BMI greater than 50 kg/m2: 60 mg subcutaneously every 12 hours

Note: Bariatric surgery guidelines suggest initiation 30 to 120 minutes before surgery and postoperatively until patient is fully mobile. Alternatively, limiting administration to the postoperative period may reduce perioperative bleeding.

Usual Geriatric Dose for Myocardial Infarction:

Acute ST segment elevation myocardial infarction:
Patients greater than or equal to 75 years of age: No initial IV bolus.
Initial dose: 0.75 mg/kg subcutaneously every 12 hours (maximum 75 mg for first two doses only, followed by 0.75 mg/kg for the remaining doses).
No dose adjustments are required for other indications unless kidney function is impaired.

Usual Pediatric Dose for Deep Vein Thrombosis -- Prophylaxis:

less than 2 months: 0.75 mg/kg subcutaneously every 12 hours.

2 months to 17 years: 0.5 mg/kg subcutaneously every 12 hours.

Usual Pediatric Dose for Deep Vein Thrombosis:

less than 2 months: 1.5 mg/kg subcutaneously every 12 hours.
2 months to 17 years: 1 mg/kg subcutaneously every 12 hours.

Alternate dosing:
Note: Several recent studies suggest that higher doses (especially in preterm neonates, neonates, and young infants) than those recommended. Some centers are using the following; however, further studies are needed to validate these proposed higher initial doses.
Premature neonates: 2 mg/kg/dose every 12 hours
Full term neonates: 1.7 mg/kg/dose every 12 hours
Infants less than 3 months: 1.8 mg/kg/dose every 12 hours
3 to 12 months: 1.5 mg/kg/dose every 12 hours
1 to 5 years: 1.2 mg/kg/dose every 12 hours
6 to 18 years: 1.1 mg/kg/dose every 12 hours

What other drugs will affect enoxaparin?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with enoxaparin, especially other medicines used to treat or prevent blood clots, such as:

  • abciximab, anagrelide, cilostazol, clopidogrel, dipyridamole, eptifibatide, ticlopidine, tirofiban;

  • alteplase, reteplase, tenecteplase, urokinase;

  • apixaban, argatroban, bivalirudin, dabigatran, desirudin, fondaparinux, lepirudin, rivaroxaban, tinzaparin; or

  • heparin.

This list is not complete. Other drugs may interact with enoxaparin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about enoxaparin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.07. Revision Date: 2014-04-13, 8:06:45 PM.

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