Enoxaparin information from DrugsUpdate
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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