Enoxaparin Sodium
Brand Name: Lovenox
Generic Available
Common Dosage Forms:
Injection (prefilled syringes): 30 mg/0.3 mL, 40 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL, 120 mg// 0.8 mL, 150 mg/1 mL
Injection (multi-dose vial): 300 mg/3 mL
FDA Indications/Dosages:
For prophylaxis of deep vein thrombosis (DVT) after abdominal surgery or in medical patients with severely restricted mobility during acute illness: 40 mg once a day for 7-10 days.
For prophylaxis of deep vein thrombosis (DVT) after hip or knee replacement: 30 mg every 12 hours beginning 12-24 hours after operation and continue for 7-10 days. May use 40 mg once daily for 3 weeks post operation.
For treatment of DVT with or without pulmonary embolism (PE): 1 mg/kg every 12 hours or 1.5 mg/kg once daily.
For use in unstable angina or non-Q-wave myocardial infarction: 1 mg/kg given every 12 hours with oral aspirin (100-325 mg).
For the treatment of acute ST-Segment Evaluation myocardial infarction: A single bolus dose of 30 mg followed by 1 mg/kg every 12 hours.
Dose in renal impairment (CrCL<30 mL/min): Lower dose to 30 mg or 1 mg/kg once daily.
Monitor: Platelet count
Pharmacology/Pharmacokinetics: Enoxaparin sodium is a low molecular weight heparin which has antithrombotic properties. In humans, enoxaparin has a higher ratio of anti-Factor Xa to anti-Factor IIa activity compared to heparin. Maximum anti-Factor Xa and antithrombin (anti-Factor IIa) activity occur 3-5 hours after SC injection. Elimination half-life based on anti-Factor Xa activity was 4.5 hours after SC injection. Anti-Factor Xa activity persists in plasma for about 12 hours.
Drug Interactions: Drugs which affect platelet function (ASPIRIN, NSAIDs, DIPYRIDAMOLE, TICLOPIDINE, etc.) may increase risk of hemorrhage and should be used with caution. Concomitant use of STREPTOKINASE AND UROKINASE may result in hemorrhage and should be avoided. Enoxaparin prolongs prothrombin time, and care should be used in evaluating this test in patients of warfarin or other anticoagulants which this test is a therapeutic monitor. Do not mix with other injections. May cause asymptomatic reversible increases in aspartate (AST) and alanine (ALT) aminotransferase levels.
Contraindications/Precautions: Contraindicated in patients hypersensitive to heparin, pork products, benzyl alcohol, or sulfites, and in patients with a history of heparin-induced thrombocytopenia or active major bleeding. Cases of epidural or spinal hematomas have been reported with the associated use of enoxaparin and spinal/epidural anesthesia or spinal puncture resulting in long-term or permanent paralysis. Pregnancy Category B.
Adverse Effects: The most common adverse reaction of parenteral administration is local reaction at the site of injection. May cause hemorrhage, edema, and anemia.
Patient Consultation:
Instruct patients how to properly inject subcutaneously.
Inform patients that it may take them longer than usual to stop bleeding and that they may bruise and/or bleed more easily during use.
Patients should report any unusual bleeding, bruising, or signs of thrombocytopenia (such as a rash of dark red spots under the skin) to their physician.
Patients should tell their physician and dentists they are taking enoxaparin and/or any other product known to affect bleeding before any surgery is scheduled and before any new drug is taken.
If a dose is missed, take it as soon as remembered and return to normal dosing schedule. Do not double doses.