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Enoxaparin information from DrugsUpdate  

See Available Brands of Enoxaparin in India

P - Caution when used during pregnancy
L - Caution when used during lactation
LI - Lab *

Enoxaparin is a low molecular weight heparin marketed as Lovenox or Clexane. It is used to prevent and treat deep vein thrombosis or pulmonary embolism, and is given as a subcutaneous injection (by a health care provider or the patient). Its use is evolving in acute coronary syndromes (ACS).
Enoxaparin is manufactured by Sanofi-Aventis and is derived from the intestinal mucosa of pigs.

Pharmacodynamics

Pharmacokinetics

Enoxaparin is a low molecular weight heparin with anticoagulant properties. It acts by enhancing the inhibition rate of activated clotting factors including thrombin and factor Xa through its action on antithrombin III.

Absorption
Rapidly and almost completely absorbed after SC inj with a bioavailability of about 100%.

Metabolism
Metabolised hepatically.

Excretion
Elimination half-life: 4-5 hours. Excreted in urine as unchanged drug and metabolites.

Enoxaparin Indications / Enoxaparin Uses

Information Not Available

Enoxaparin Adverse Reactions / Enoxaparin Side Effects

Thrombocytopenia, mild bleeding, inj site irritation, pain and ecchymoses, hypersensitivity and erythema.

Potentially Fatal: Haemorrhagic complications.

Precautions

Warnings

Spinal/Epidural hematomas
Risk of spinal/epidural hematoma increased in patients receiving neuraxial anesthesia or spinal puncture and who are anticoagulated with LMWH or heparinoids. Other risk factors include indwelling epidural catheters, repeated or traumatic epidural or spinal puncture, or other drugs affecting hemostasis (eg, NSAIDs, platelet inhibitors, anticoagulants). Risk of long-term or permanent paralysis. Monitor frequently for signs/symptoms of neurological impairment.

Monitor
Periodic CBCs, including platelet count, and stool occult blood tests are recommended.

Special Precautions

Renal or hepatic impairment, history of GI ulceration, uncontrolled hypertension, spinal or epidural anaesthesia; lactation and pregnancy; elderly. Periodic blood counts, platelet count and stool occult blood test recommended.

Other Drug Interactions

Anticoagulants, NSAIDs, platelet inhibitors

Other Interactions

Information Not Available

Dosage

Subcutaneous
Prophylaxis of venous thromboembolism during surgical procedures
Adult: Low to moderate risk: 20 mg (2000 units) once daily with the 1st dose 2 hr pre-operatively. High risk: 40 mg (4000 units) once daily with the 1st dose 12 hr pre-operatively. Alternatively, 30 mg (3000 units) bid starting within 12-24 hr after the operation. After hip replacement surgery, continue treatment at 40 mg once daily for a further 3 wk. For immobilised patients, treatment should continue at 40 mg daily for at least 6 days or until patient becomes fully ambulant, up to a max of 14 days.
CrCl (ml/min)    Dosage Recommendation
<30        Reduce dose. Max: 1 mg/kg/day.

Subcutaneous
Deep vein thrombosis
Adult: 1 mg (100 units)/kg every 12 hr for 5 days and until oral anticoagulation is established.
CrCl (ml/min)    Dosage Recommendation
<30        Reduce dose. Max: 1 mg/kg/day.

Subcutaneous
Prevention of clotting in the extracorporeal circulation during haemodialysis
Adult: 1 mg/kg (100 units/kg) into the arterial line of the circuit at the beginning of the dialysis session. Give a further dose of 0.5-1 mg/kg (50-100 units/kg) if required. Reduce dose in patients at high risk of haemorrhage.
CrCl (ml/min)    Dosage Recommendation
<30        Reduce dose. Max: 1 mg/kg/day.

Subcutaneous
Unstable angina
Adult: 1 mg/kg (100 units/kg) every 12 hr for 2-8 days with low-dose aspirin.
CrCl (ml/min)    Dosage Recommendation
<30        Reduce dose. Max: 1 mg/kg/day.

Food(before/after)

Information Not Available

List of Contraindications

Enoxaparin and Pregnancy

Caution when used during pregnancy.

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Enoxaparin and Lactation

Caution when used during lactation

Enoxaparin and Children

Safety and efficacy not established

Enoxaparin and Geriatic

Delayed elimination of drug possible. Use with caution

Enoxaparin and Other Contraindications

Hypersensitivity, acute bacterial endocarditis; major bleeding disorder, haemorrhagic stroke, drug-induced thrombocytopenia.

Storage

Subcutaneous
Store at 25°C.

Lab interference

Subcutaneous
Store at 25°C.

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