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Drugs reference index «enoxaparin»

enoxaparin


enoxaparin

Generic Name: enoxaparin (ee nox AP a rin)Brand names: Lovenox, Lovenox HP, Clexane, Clexane Forte

What is enoxaparin?

Enoxaparin is an anticoagulant (blood thinner) that prevents the formation of blood clots.

Enoxaparin is used to prevent blood clots that are sometimes called deep vein thrombosis (DVT), which can lead to blood clots in the lungs. A DVT can occur after certain types of surgery, or in people who are bed-ridden due to a prolonged illness. DVT sometimes occurs suddenly for other reasons.

Enoxaparin is also used to prevent blood vessel complications in people with certain types of angina (chest pain) or heart attack.

Enoxaparin may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about enoxaparin?

You should not receive this medication if you are allergic to enoxaparin, heparin, or pork products, or if you have uncontrolled bleeding, a severe lack of platelets in your blood, or if you are having surgery with spinal or epidural anesthesia.

Before you receive enoxaparin, tell your doctor if you have eye problems caused by diabetes, an infection of your heart, uncontrolled high blood pressure, a history of stroke, a bleeding or blood clotting disorder, stomach or intestinal bleeding or ulcer, kidney or liver disease, a genetic spinal defect or recent surgery, recent eye or brain surgery; an allergy to benzyl alcohol, or if you have ever had low blood platelets after receiving heparin.

Avoid taking aspirin unless your doctor recommends it as part of your treatment. Aspirin can increase your risk of bleeding.

Tell your doctor about all medications you use. Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding, and it is very important to tell your doctor if you are using any of them before you start using enoxaparin. This includes blood thinners, aspirin, NSAIDs (such as Advil, Motrin Aleve, Orudis), or other medications used to treat or prevent blood clots.

If you need surgery, dental work, or a medical procedure (especially with spinal or epidural anesthesia), tell the doctor or dentist ahead of time that you are using enoxaparin. You may need special care to prevent bleeding.

What should I discuss with my healthcare provider before receiving enoxaparin?

You should not receive enoxaparin if you are allergic to it, or if you have:
  • uncontrolled bleeding;

  • a severe lack of platelets in your blood; or

  • if you are allergic to heparin or pork products.

If you have any of these other conditions, you may need a enoxaparin dose adjustment or special tests:

  • eye problems caused by diabetes;

  • an infection of the lining of your heart (also called bacterial endocarditis);

  • a history of stroke;

  • uncontrolled high blood pressure;

  • a bleeding or blood clotting disorder, such as hemophilia;

  • stomach or intestinal bleeding or ulcer;

  • kidney or liver disease;
  • a genetic spinal defect;

  • recent eye, brain, or spinal surgery;

  • an allergy to benzyl alcohol; or

  • if you have ever had low blood platelets after receiving heparin.

FDA pregnancy category B. Enoxaparin is not expected to harm an unborn baby. However, some forms of this medication contain a preservative that may be harmful. Tell your doctor if you are pregnant or plan to become pregnant during treatment. If you use this medication during pregnancy, make sure your doctor knows if you have a mechanical heart valve. It is not known whether enoxaparin passes into breast milk or if it could harm a nursing baby. Do not receive this medication without telling your doctor if you are breast-feeding a baby.

How should I use enoxaparin?

Enoxaparin is injected under the skin. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Enoxaparin is sometimes injected into a vein through an IV.

You should be sitting or lying down while receiving an enoxaparin injection.

Do not mix enoxaparin with other medications in the same syringe unless your doctor tells you to.

Use a different place on your stomach each time you give the injection. Your care provider will show you the best places on your body to inject the medication. Do not inject into the same place two times in a row. Do not inject enoxaparin into a muscle.

Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your stool (bowel movement) may also need to be tested. Visit your doctor regularly.

If you need surgery, dental work, or a medical procedure (especially with spinal or epidural anesthesia), tell the doctor or dentist ahead of time that you are using enoxaparin. You may need special care to prevent bleeding. Store at room temperature away from moisture and heat.

Do not use any medication that is discolored or that has particles in it. Call your doctor for a new prescription.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose may cause excessive bleeding.

What should I avoid while using enoxaparin?

Avoid taking aspirin unless your doctor recommends it as part of your treatment. Aspirin can increase your risk of bleeding.

Enoxaparin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; itching or burning skin; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using enoxaparin and call your doctor at once if you have a serious side effect such as:
  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), any bleeding that will not stop;

  • purple or red pinpoint spots under your skin;

  • blood in your urine or stools, black or tarry stools;

  • coughing up blood or vomit that looks like coffee grounds;

  • pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

  • bruising, bleeding, swelling, or skin changes where the medicine was injected;

  • sudden numbness or weakness, especially on one side of the body;

  • sudden headache, confusion, problems with vision, speech, or balance;

  • pain or swelling in one or both legs; or

  • trouble breathing.

Less serious side effects include mild pain, redness, or warmth where the medicine was injected.

  • diarrhea;

  • fever;

  • swelling in your hands or feet; or

  • mild pain, irritation, or redness where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Enoxaparin Dosing Information

Usual Adult Dose for Deep Vein Thrombosis -- Prophylaxis:

40 mg subcutaneously once a day. The usual duration of administration is 6 to 11 days; up to 14 days administration has been well tolerated in clinical trials.

Usual Adult Dose for Deep Vein Thrombosis:

Outpatient: 1 mg/kg subcutaneously every 12 hoursInpatient: 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg subcutaneously once a day at the same time every day. In both outpatient and inpatient treatments, warfarin sodium therapy should be initiated on the same day of starting enoxaparin. Enoxaparin should be continued for a minimum of 5 days and until a therapeutic oral anticoagulant effect has been achieved (INR 2.0 to 3.0). The average duration of administration is 7 days; up to 17 days of has been well tolerated in controlled clinical trials.

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 daily). Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.Acute ST-segment elevation myocardial infarction: single 30 mg intravenous bolus plus a 1 mg/kg subcutaneous dose 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). 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 daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. For patients managed by 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 intravenous bolus of 0.3 mg/kg should be given.

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 daily). Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.Acute ST-segment elevation myocardial infarction: single 30 mg intravenous bolus plus a 1 mg/kg subcutaneous dose 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). 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 daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. For patients managed by 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 intravenous bolus of 0.3 mg/kg should be given.

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 daily). Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.Acute ST-segment elevation myocardial infarction: single 30 mg intravenous bolus plus a 1 mg/kg subcutaneous dose 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). 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 daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. For patients managed by 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 intravenous bolus of 0.3 mg/kg should be given.

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. The usual duration of administration is 7 to 10 days; up to 14 days administration has been well tolerated in clinical trials.

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. The usual duration of administration is 7 to 10 days; up to 14 days administration has been well tolerated in clinical trials.

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. The usual duration of administration is 7 to 10 days; up to 12 days administration has been well tolerated in clinical trials.

Usual Geriatric Dose for Myocardial Infarction:

Acute ST-segment elevation myocardial infarction:Patients greater than or equal to 75 years of age: No initial IV bolus. 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).No dose adjustments are required for other indications unless kidney function is impaired.

Usual Pediatric Dose for Deep Vein Thrombosis -- Prophylaxis:

<2 months: 0.75 mg/kg subcutaneously every 12 hours.>=2 months and <18 years: 0.5 mg/kg subcutaneously every 12 hours.

Usual Pediatric Dose for Deep Vein Thrombosis:

<2 months: 1.5 mg/kg subcutaneously every 12 hours.>=2 months and <18 years: 1 mg/kg subcutaneously every 12 hours.

What other drugs will affect enoxaparin?

There are many other drugs that can increase your risk of bleeding, and it is very important to tell your doctor if you are using any of them before you start using enoxaparin. This includes:
  • a blood thinner such as warfarin (Coumadin);

  • other medications used to prevent blood clots, such as alteplase (Activase), clopidogrel (Plavix), dipyridamole (Persantine), ticlopidine (Ticlid), and urokinase (Abbokinase);

  • salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan's Pills Extra Strength, Pepto-Bismol, Tricosal, and others; or

  • NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.

This list is not complete and other drugs may interact with enoxaparin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about enoxaparin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 8.01. Revision Date: 02/04/2010 4:39:31 PM.
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