Enoxaparin (Subcutaneous)

Enoxparin is also known under US brand name Lovenox and is used in the prevention and treatment of harmful blood clots, helping to reduce the risk of a heart attack or stroke.

Overview

Enoxaparin is a drug used in the prevention of deep venous thrombosis, which is a condition where blood clots become harmful and form in the blood vessels of your legs. These can then travel to your lungs becoming lodged in the lung's blood vessels which leads to a condition known as pulmonary embolism. This medication is used for several days after knee or hip replacement surgery, and in other cases following abdominal surgery, when you can't walk. It's during this time that blood clots are most likely to develop. This drug is also used if you are unable to get out of bed due to a serious illness. It's also used to prevent blood clots from forming in the arteries of the heart during certain types of heart attacks and chest pain.

This drug is used in combination alongside another drug to treat a condition known as deep vein thrombosis with/or without the addition of pulmonary embolism. It's also used in the treatment of some strains of various heart attacks. You can only obtain this medication via your doctor's prescription and it is available via the dosage form of a solution.

Condition(s) treated?

  • Blood clot in a deep vein of the extremities

Type of medicine?

  • Solution for injection

Side Effects

Along with its intended effects, the use of enoxaparin can produce some unwanted side effects, not all of these side effects may be apparent, however. If they are, you may need to seek medical attention. You should consult with your healthcare professional or doctor if you suffer from any of the following side effects whilst taking enoxaparin.

More common side effects

  • Red or black, tarry stools

Less common side effects

  • Confusion

Rare side effects

  • General feeling of discomfort or illness

Incidence not known

  • Vomiting or nausea

Some side effects that occur with enoxaparin can occur that usually don't require medical attention. You usually find these side effects begin to reduce or disappear once your body begins to adjust to the medication. If they are giving you bother, you should contact your doctor or healthcare professional about ways to reduce or prevent these side effects. Seek advice from your healthcare professional if you suffer from any of the following side effects whilst taking this medication, or they begin to worsen.

Less common side effects

  • Irritation, pain, or redness at the place of injection

Remember you can report all side effects to the FDA.

Dosage

The final dose of any medication will depend on a number of factors. These will include your weight, age and height. Your doctor will also take into consideration any other medications you are currently taking, including any other medical conditions that you suffer from. Your reaction to the first dose may also determine your final dose. The following doses are only typical and to be used as a guideline.

Typical dose for injection form

For prevention of blood clots after non'Q-wave myocardial infarction (a type of heart attack) or unstable angina (chest pain):

Adults: The final dose is based on body weight and is determined by your doctor. Typically the dose is usually 1 milligram per kilogram of body weight which is injected under the skin every 12 hours for two to eight days. You can also be given 100 to 325 mg of aspirin once a day orally. However, if you have a poorly performing kidney, the dose is 1 mg per kg once daily.

Children: The final dose and use will be determined by a healthcare professional or doctor.

For prevention of deep venous thrombosis (abdominal surgery):

Adults: 40 milligrams is injected under the skin once daily for seven to ten days. The first dose should be given two hours prior to surgery. However, if you have a poor performing kidney then the dose is 30 mg once daily.

Children: The final dose and use will be determined by your doctor.

For prevention of deep venous thrombosis (knee or hip replacement surgery):

Adults: 30 milligrams is injected under the skin every 12 hours for seven to ten days. However, if you have a poorly functioning kidney then the dose is 30mg once daily.

For prevention of deep venous thrombosis (in patients with a serious illness who cannot get out of bed):

Adults: 40 milligrams is injected under the skin once daily for six to eleven days. However, if you have a poorly functioning kidney then the dose is 30 mg once daily.

For treatment of acute deep vein thrombosis with or without pulmonary embolism:

Adults: The final dosage is a based on your body weight and will be indicated by your doctor or healthcare professional. However, as a guide, the dose is usually 1 mg per kilo of body weight every twelve hours by injection under the skin for a period of seven days. If your kidney doesn't perform well, then the dose is adjusted to 1 mg per day.

For treatment of certain type of acute heart attack:

Adults: The final dosage is based on your weight and will be given by your doctor. However, the typical dose is 30 mg which is injected into your vein and based on the ratio of 1 mg per kilo of body weight, followed by 1 mg per kg every twelve hours injected under the skin for eight days. You can also receive aspirin at a dose of 75 to 325 mg orally daily.

Older adults: The final dose is determined by your doctor as it is based on body weight; however, the dose to start with is typically 0.75 milligram per kilo of body weight injected under the skin every twelve hours for eight days.

Missed dose

If you miss a dose of this medication, then take it as soon as you remember. However, if it is close to your next scheduled dose, then skip the missed dose and revert back to your original dosing schedule. Under no circumstances should you double a dose.

Interactions

Drug interactions can cause severe side effects and reduce the effectiveness of some of the drugs. Your doctor may alter the drugs you are taking. To lessen the risk of these side effects you should let your doctor know all of the current and past medications you are taking. This includes prescription and nonprescription drugs, all vitamins and herbal products or remedies. You should also let your doctor or healthcare professional know of any other medical conditions that you suffer from as they could increase your risk of interactions. Include any medical conditions that run in the family. Do not stop taking any drugs without consulting your doctor first.

The use of this medication alongside any of the following medications is not usually recommended. Your doctor may avoid treating you with this drug altogether, or change of some of the other medicine you are taking.

  • Defibrotide

The use of this medication with any of the following drugs is not recommended, but in some cases, it may be the best treatment for you. If both drugs are prescribed together, your doctor may alter the dose or frequency in which you use both medications.

  • Clopidogrel

There are over 140 drugs that interact moderately with this drug. Let your doctor know if you are taking any of the following medications.

  • Milnacipran

Do not stop, start or alter any dose of medication without consulting your doctor beforehand. Remember that this list is not complete so it's important to let your doctor or healthcare professional know of all drugs you are currently taking to help avoid serious interactions.

Other Medical Problems

If you suffer from any other medical conditions, this could cause interactions and affect the proper use of this medication. Ensure that you tell your doctor or healthcare professional of all the other medical conditions you suffer from.

Allergies

Let your doctor or healthcare professional know if you suffered from any reactions to this medication or other medications. You should also let them know if you suffer from any other types of allergies including, dyes, animals, preservatives or foods.

Use of medication in pediatric population

Studies have not been conducted on the relationship of age to the effects of enoxaparin on the younger population. Therefore efficacy and safety have not yet been established.

Use of medication in geriatric population

Studies conducted to date have not indicated a geriatric-specific problem that could limit the effectiveness of enoxaparin in the older population. However, elderly patients are more likely to have age-related kidney disease and bleeding problems, which may require an adjustment in the dose for those who are receiving this drug, especially if they weigh less than 45 kilograms (99 lb).

Use in pregnancy and breastfeeding

This drug is listed under FDA pregnancy category B. Enoxaparin is not known to harm an unborn child. However, some forms of this drug do contain a preservative that may be harmful to a newborn child. Inform your doctor or healthcare professional if you are pregnant or plan on falling pregnant whilst being treated with this medication. If you use this drug during pregnancy, ensure doctor knows if you suffer from a mechanical heart valve.

With regards to breastfeeding, it's unknown whether this drug passes into breast milk or if it could cause harm to a nursing infant. Therefore, you shouldn't breastfeed whilst use this medication. Speak with your doctor or a healthcare professional.

Warnings

This drug is usually given by a medical professional in a clinical setting; however, if you are using this drug at home, your doctor will show you how to inject yourself with the medication. Ensure you follow these directions carefully. Seek help if you do not know what you are doing.

Your doctor will show you all the specific areas of the body where you can give this shot. Rotate body areas each time you give yourself an injection. To help prevent skin issues arising from the injection area, you should keep track of where you give each injection.

If the color of the mediation in the prefilled syringe has changed, or there are particles floating in it, under no circumstances should you use it.

Storage

This medication should be stored in a closed container at room temperature, away from moisture, heat and direct light. Do not let this medication freeze. Keep out of the reach of children. Do not keep any medication you no longer need or has gone out of date. Seek advice from a local pharmacist or healthcare professional about how to dispose of medication you do not need.

If you were given a bottle of medication to use with your syringes, you must use the medication within a twenty-eight day period after the first injection. Throw away the unused medication in the bottle after twenty-eight days.

Dispose of used needles in a closed, hard container that the needles cannot pinch through. Ensure this container is kept away from pets and children.

It's vital that you let your doctor check your progress at regular visits to ensure this medication is working as intended. Regular blood tests can check for unwanted effects. Ensure you keep all scheduled appointments.

You may bruise or bleed more easily when using this medication. Ensure you avoid rough sports or other situations that could cause you to obtain cuts, bruises or injuries. Exercise caution when using sharp objects such as fingernail clippers and razors and avoid picking your nose and forcefully blowing your nose.

Let any dentist or doctor who treats you know that you are using this medication. You may need to stop using this medication several days before having medical tests or surgery.

This drug can cause bleeding problems. The risk is higher if you have a catheter in your back for pain medication or anesthesia or if you suffer from kidney problems. If your kidneys get worse, then the risk of bleeding increases. Consult your healthcare professional or doctor immediately if you have any unusual bruising or bleeding, tarry, black stools, bleeding from the gums, blood in the stools or urine, tingling, weakness or numbness, in the lower legs or pinpoint red spots on your skin.

Be careful when using dental floss, a regular toothbrush or a toothpick. Your medical dentist or nurse may advise other ways to clean your gums and teeth. Check with a medical professional before engaging in any dental work.

Ensure your doctor knows if you have received enoxaparin or heparin before and suffered from a reaction known as thrombocytopenia, or if new blood clots formed whilst you were receiving the medication.

Let your doctor or healthcare professional know or if you have recently given birth, fallen or suffered a blow to the head or body or had dental or medical surgery. These could increase your risk of serious bleeding whilst taking this drug.

Lovenox in multiple-dose vials contains a preservative benzyl alcohol, which can cause allergic reactions. Tell your doctor immediately if you are pregnant or have ever suffered from an allergic reaction to benzyl alcohol.

Do not take other medicines unless they have been discussed with your doctor.

Summary

When used correctly, Enoxaparin is successful in the treatment of deep venous thrombosis. This drug should not be used whilst breastfeeding and you should let your doctor know if you are pregnant or are planning to become pregnant whilst using this drug. The use of this drug in children should be determined by your doctor. Due to a large number of interactions possible, it's important that you let your doctor know of all current and past medications you are taking and any medical conditions you suffer from. Contact your doctor or a healthcare professional if you have any questions or queries about the use of this medication.

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