Generic Name: Enoxaparin Brand Name(s): Enoxaparin.

Uses

What is Enoxaparin used for?

Enoxaparin is commonly used to prevent and treat harmful blood clots. This helps to reduce the risk of a stroke or heart attack. This medication helps keep your blood flowing smoothly by lowering the activity of clotting proteins in the blood. Enoxaparin is an anticoagulant, also known as a “blood thinner.” It is a type of heparin.

Conditions which increase your risk of developing blood clots include certain types of surgeries (such as knee/hip replacement, abdominal), long periods of being immobile, certain types of heart attack, and a specific type of chest pain called unstable angina. For some medical conditions, enoxaparin may be used in combination with other “blood thinners.

How should I take Enoxaparin?

This medication is given by injection under the skin as directed by your doctor, usually once or twice a day in the abdomen (at least 2 inches from your belly button). Do not inject into a muscle. The dosage and length of treatment are based on your medical condition and response to treatment. The dosage may also be based on your age and weight for some conditions. Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time(s) each day.

If you are using this medication at home, learn all preparation and usage instructions from your health care professional and the product package. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Before injecting each dose, clean the injection site with rubbing alcohol. Change the injection site each time to lessen injury under the skin. To minimize bruising, do not rub the injection site after a shot. Learn how to store and discard medical supplies safely.

This medication may also be given by injection into a vein by a health care professional, as directed by your doctor.

How do I store Enoxaparin?

Enoxaparin is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Enoxaparin in the bathroom or the freezer. There may be different brands of Enoxaparin that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Enoxaparin down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Enoxaparin?

Before using enoxaparin, tell your doctor or pharmacist if you are allergic to it; or to heparin or pork products; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using enoxaparin, tell your doctor or pharmacist your medical history, especially of: serious active bleeding, artificial heart valve(s), kidney disease, liver disease, bleeding or blood disorders (such as low platelet counts), low platelet counts after previous heparin treatment, stroke, uncontrolled severe high blood pressure, certain eye problems (such as diabetic retinopathy), certain stomach/intestinal problems (such as active or recent ulcers), recent spinal procedure or puncture, spine problems (such as spinal deformity), recent eye/brain/spinal cord surgery.

Limit alcohol while taking this drug because it may increase the risk of stomach bleeding.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Older adults may be more sensitive to the side effects of this drug, especially bleeding.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Pregnant women with artificial heart valves need close monitoring.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Enoxaparin during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this Enoxaparin. This Enoxaparin is pregnancy risk category B according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Enoxaparin?

Mild irritation, pain, bruising, redness, and swelling at the injection site may occur. Fatigue or fever may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication can cause bleeding if its effect on your blood clotting proteins is too much. Tell your doctor right away if you have any serious signs of bleeding, including: unusual pain/swelling/discomfort, unusual or prolonged bleeding, unusual or easy bruising, dark urine, black stools, severe headache, confusion, vision changes, unusual dizziness, fainting, seizures, weakness, numbness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Enoxaparin?

A product that may interact with this drug is: mifepristone.

This medication is sometimes used together with other drugs that have “blood thinning” or anti-platelet effects such as aspirin, clopidogrel, or warfarin. When these combinations are prescribed by your doctor, you will require closer monitoring to minimize your risk of bleeding. Keep all medical and laboratory appointments.

Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as ibuprofen, naproxen, or aspirin) which can increase the risk of bleeding/anti-platelet effect when used with enoxaparin. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

Enoxaparin may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Enoxaparin?

Enoxaparin may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Enoxaparin?

Enoxaparin may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Enoxaparin.

What is the dose of Enoxaparin for an adult?

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.

Duration of therapy: At least 5 days and until a therapeutic oral anticoagulant effect has been achieved (INR 2 to 3). Average duration is 7 days; up to 17 days has been well tolerated in controlled clinical trials.

Comments: In both outpatient and inpatient treatments, warfarin sodium therapy should be initiated when appropriate (usually within 72 hours of commencing enoxaparin).

Uses:

-Outpatient treatment of acute deep vein thrombosis (DVT) without pulmonary embolism (PE) when administered in conjunction with warfarin sodium.

-Inpatient treatment of acute DVT with or without PE when administered in conjunction with warfarin sodium.

Usual Adult Dose for Deep Vein Thrombosis – Prophylaxis

40 mg subcutaneously once a day

Duration of therapy: Usually 6 to 11 days; up to 14 days has been well tolerated in clinical trials.

Use: Prophylaxis of deep vein thrombosis (DVT) in medical patients at risk for thromboembolic complications due to severely restricted mobility during acute illness.

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 a day)

Duration of therapy: At least 2 days and until clinical stabilization. Usual duration is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.

Use: Prophylaxis of ischemic complications of unstable angina and non Q wave myocardial infarction, when concurrently administered with aspirin.

Acute ST-Segment Elevation Myocardial Infarction (STEMI):

30 mg IV bolus once plus 1 mg/kg subcutaneously once 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)

Duration of therapy: Optimal duration is unknown, but it is likely to be longer than 8 days.

Comments:

-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 a day unless contraindicated).

-For patients managed by percutaneous coronary intervention (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 IV bolus of 0.3 mg/kg should be given.

Use: Prophylaxis of recurrent myocardial infarction or death in patients with acute STEMI receiving thrombolysis and being managed medically or with PCI, when concurrently administered with aspirin.

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 a day)

Duration of therapy: At least 2 days and until clinical stabilization. Usual duration is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.

Use: Prophylaxis of ischemic complications of unstable angina and non Q wave myocardial infarction, when concurrently administered with aspirin.

Acute ST-Segment Elevation Myocardial Infarction (STEMI):

30 mg IV bolus once plus 1 mg/kg subcutaneously once 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)

Duration of therapy: Optimal duration is unknown, but it is likely to be longer than 8 days.

Comments:

-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 a day unless contraindicated).

-For patients managed by percutaneous coronary intervention (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 IV bolus of 0.3 mg/kg should be given.

Use: Prophylaxis of recurrent myocardial infarction or death in patients with acute STEMI receiving thrombolysis and being managed medically or with PCI, when concurrently administered with aspirin.

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 a day)

Duration of therapy: At least 2 days and until clinical stabilization. Usual duration is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.

Use: Prophylaxis of ischemic complications of unstable angina and non Q wave myocardial infarction, when concurrently administered with aspirin.

Acute ST-Segment Elevation Myocardial Infarction (STEMI):

30 mg IV bolus once plus 1 mg/kg subcutaneously once 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)

Duration of therapy: Optimal duration is unknown, but it is likely to be longer than 8 days.

Comments:

-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 a day unless contraindicated).

-For patients managed by percutaneous coronary intervention (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 IV bolus of 0.3 mg/kg should be given.

Use: Prophylaxis of recurrent myocardial infarction or death in patients with acute STEMI receiving thrombolysis and being managed medically or with PCI, when concurrently administered with aspirin.

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.

Duration of therapy: Usually 7 to 10 days; up to 14 days has been well tolerated in clinical trials.

Uses:

-Prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip replacement surgery, during and following hospitalization.

-Prophylaxis of DVT in patients undergoing knee replacement surgery.

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.

Duration of therapy: Usually 7 to 10 days; up to 14 days has been well tolerated in clinical trials.

Uses:

-Prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip replacement surgery, during and following hospitalization.

-Prophylaxis of DVT in patients undergoing knee replacement surgery.

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

Duration of therapy: Usually 7 to 10 days; up to 12 days has been well tolerated in clinical trials.

Use: Prophylaxis of deep vein thrombosis (DVT) in patients undergoing abdominal surgery who are at risk for thromboembolic complications.

Usual Geriatric Dose for Myocardial Infarction

75 Years or Older:

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).

Comments:

-Do not use an initial IV bolus.

-No dose adjustments are required for other indications unless kidney function is impaired.

Use: Treatment of acute ST-segment elevation myocardial infarction.

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl 30 to 80 mL/min): Use with caution

Severe renal dysfunction (CrCl less than 30 mL/min):

-Prophylaxis in abdominal surgery: 30 mg subcutaneously once a day

-Prophylaxis in hip or knee replacement surgery: 30 mg subcutaneously once a day

-Prophylaxis in medical patients during acute illness: 30 mg subcutaneously once a day

-Outpatient treatment of acute deep vein thrombosis (DVT) without pulmonary (PE) (in conjunction with warfarin therapy): 1 mg/kg subcutaneously once a day

-Inpatient treatment of acute DVT with or without PE (in conjunction with warfarin therapy): 1 mg/kg subcutaneously once a day

-Prophylaxis of ischemic complications of unstable angina and non Q wave myocardial infarction (administered with aspirin): 1 mg/kg subcutaneously once a day

-Treatment of acute ST-segment elevation myocardial infarction (STEMI) in patients less than 75 years old (administered with aspirin): 30 mg IV bolus once plus 1 mg/kg subcutaneously once followed by 1 mg/kg subcutaneously once a day

-Treatment of acute STEMI in patients 75 years or older (administered with aspirin): 1 mg/kg subcutaneously once a day (no initial bolus)

Liver Dose Adjustments

Use with caution

Other Comments

Administration advice: The manufacturer product information should be consulted.

Storage requirements: Do not store multiple-use vials for more than 28 days after the first use.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

IV compatibility:

-For subcutaneous use, this drug should not be mixed with other injections or infusions.

-For IV use, this drug can be mixed with normal saline solution (0.9%) or 5% dextrose in water.

General: This drug is characterized by a higher ratio of antithrombotic (anti-Factor Xa) activity to anticoagulant (anti-Factor IIa) activity compared to heparin.

Monitoring:

-Hematologic: Coagulation tests and complete blood count (the manufacturer product information and institution-specific protocol should be consulted).

Patient advice:

-If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus and the mother.

-Instruct patients to inform a healthcare professional immediately if they experience any signs or symptoms of neurological impairment, such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), or bowel and/or bladder dysfunction.

What is the dose of Enoxaparin for a child?

Usual Pediatric Dose for Deep Vein Thrombosis

American College of Chest Physicians (ACCP) recommends the following:

Less than 2 months: 1.5 mg/kg subcutaneously every 12 hours

2 months to 17 years: 1 mg/kg subcutaneously every 12 hours

Usual Pediatric Dose for Deep Vein Thrombosis – Prophylaxis

American College of Chest Physicians (ACCP) recommends the following:

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

How is Enoxaparin available?

Enoxaparin is available in the following dosage forms and strengths:

  • Subcutaneous Syringe
  • Subcutaneous Solution

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Enoxaparin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: January 24, 2018 | Last Modified: January 24, 2018

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