Enoxaparin

Generic Name: Enoxaparin

Enoxaparin is prescription medication used for as prophylaxis treatment of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing abdominal surgery, hip replacement surgery (during and following hospitalization), knee replacement surgery and in medical patient who are at risk for thromboembolic complications due to severe restricted mobility during acute illness.

Enoxaparin is available under the following different brand names: Lovenox.

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Enoxaparin binds to and potentiates antithrombin (a circulating anticoagulant) to form a complex that irreversibly inactivates clotting factor Xa. It has less activity against factor IIa (thrombin) compared to unfractionated heparin (UFH) due to its low molecular weight.

Enoxaparin has predictable absorption, bioavailability, and distribution therefore monitoring is not typically done. However, there are instances where monitoring may be beneficial for special populations, for example individuals with kidney insufficiency or those that are obese. In this case, anti-Xa units can be measured and dosing adjusted accordingly.

Side effects of enoxaparin include:

  • bleeding
  • elevation of serum aminotransferases
  • fever
  • local site reactions
  • low blood platelet count
  • nausea
  • anemia
  • bruising
  • irregular, rapid heart rate (atrial fibrillation)
  • heart failure
  • excess fluid in the lungs (pulmonary edema)
  • pneumonia
  • shortness of breath
  • confusion
  • diarrhea
  • blood in the urine

Postmarketing side effects of enoxaparin reported include:

  • Reports of epidural or spinal hematoma formation when coadministered with spinal/epidural anesthesia or spinal puncture
  • Local reactions at the injection site (nodules, inflammation, oozing), systemic allergic reactions (itching, hives, severe allergic reaction(anaphylactic/anaphylactoid reactions including shock), fluid filled blisters (vesiculobullous rash), rare cases of hypersensitivity inflammation of blood vessels in the skin, skin discoloration, skin necrosis (occurring at either the injection site or distant from the injection site), elevated blood platelet count, and low blood platelet count with blood clots
  • Elevated potassium level in the blood
  • Cases of headache, acute blood loss (hemorrhagic anemia), elevated eosinophils in the blood, hair loss, infection of the liver and impaired bile formation or bile flow causing liver disease reported
  • Osteoporosis following long-term therapy

Dosage of Enoxaparin:

Multidose vial

  • 100 mg/ml (3 ml/vial)

Prefilled syringe

  • 30 mg/0.3 ml
  • 40 mg/0.4 ml
  • 60 mg/0.6 ml
  • 80 mg/0.8 ml
  • 100 mg/ml
  • 120 mg/0.8 ml
  • 150 mg/ml

Adults

Abdominal surgery

  • 40 mg subcutaneously each day; initiate 2 hours preoperatively

Knee or hip replacement surgery

  • 30 mg subcutaneously every 12 hours; initiate therapy 12-24 hours postoperatively and continued for 10 days or up to 35 days postoperatively or until risk of deep veinthrombosis has been significantly reduced or patient is on anticoagulant therapy
  • For hip replacement surgery, may consider administering 40 mg subcutaneously each day, initiated 9-15 hours preoperatively and continued for 10 days or up to 35 days postoperatively or until risk of deep vein thrombosis has been significantly reduced or patient is on anticoagulant therapy

Medical patients with restricted mobility

  • 40 mg subcutaneously each day; continue until risk of deep vein thrombosis has been significantly (6-11 days) reduced or patient is on anticoagulant therapy

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe interactions of enoxaparin include:

  • defibrotide
  • mifepristone
  • prothrombin complex concentrate, human

Enoxaparin has serious interactions with at least 68 different drugs.

Enoxaparin has moderate interactions with at least 135 different drugs.

Mild interactions of enoxaparin include:

  • acetaminophen
  • acetaminophen, intravenously
  • acetaminophen, rectally
  • alprostadil intravenous/urethral
  • ceftaroline
  • chlorella
  • demeclocycline
  • dexmethylphenidate
  • docycycline
  • glyburide
  • lymecycline
  • mineral oil
  • minocycline
  • oxytetracycline
  • quinidine
  • tetracycline
  • verteporfin
  • vitamin E

This medication contains enoxaparin. Do not take Lovenox if you are allergic to enoxaparin or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Epidural or spinal hematomas may occur in patient's anticoagulated with low-molecular-weight heparin (LMWH) or heparinoids who receive neuraxial (epidural/spinal) anesthesia or spinal puncture

These hematomas may result in long-term or permanent paralysis

Patients should be frequently monitored for signs and symptoms of neurologic impairment (tingling, numbness, muscular weakness)

If neurologic compromise is noted, urgent treatment is necessary

Physicians should consider the benefits versus risk before neuraxial intervention in patient's anticoagulated or to be anticoagulated for thromboprophylaxis

Factors increasing risk of epidural or spinal hematomas:

  • Indwelling epidural catheters.
  • Concomitant use of other drugs that affect hemostasis (nonsteroidal anti-inflammatory drugs [NSAIDs], platelet inhibitors, other anticoagulants).
  • History of traumatic or repeated epidural or spinal punctures.
  • History of spinal deformity or spinal surgery.
  • Appropriate timing of enoxaparin dosing in relation to catheter placement or removal.
  • Optimal timing between the administration of enoxaparin and neuraxial procedures is not known.
  • Placement or removal of a spinal catheter should be delayed for at least 12 hour after administration of prophylactic doses (doses used for deep vein thrombosis prevention).
  • Longer delays (24 hour) are appropriate to consider for patients receiving higher therapeutic doses (enoxaparin 1 mg/kg twice daily or 1.5 mg/kg per day).
  • A post procedure dose of enoxaparin should usually be given no sooner than 4 hour after catheter removal.
  • In all cases, a benefit-risk assessment should consider both the risk for thrombosis and the risk for bleeding in the context of the procedure and patient risk factors

All Relative Medicines

ENOXAPARIN
CLEXANE

(2prefilledsyringe Inj.) of 40mg/0.4ml
Rs. 461.36 INR
View Details

ENOXAPARIN
LMWX

(0.8ml Inj.) of 80mg
Rs. 546.00 INR
View Details

ENOXAPARIN
LMWX

(0.6ml Inj.) of 60mg
Rs. 475.00 INR
View Details

ENOXAPARIN
LMWX

(0.2ml Inj.) of 20mg
Rs. 230.00 INR
View Details

ENOXAPARIN SODIUM
ENCLEX

(0.6ml Inj.) of 60mg
Rs. 520.00 INR
View Details

ENOXAPARIN
LMWX

(0.4ml Inj.) of 40mg
Rs. 374.00 INR
View Details

ENOXAPARIN SODIUM
ENCLEX

(0.4ml Inj.) of 40mg
Rs. 410.00 INR
View Details

ENOXAPARIN
CLEXANE

(2prefilledsyringe Inj.) of 20mg/0.2ml
Rs. INR
View Details

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