enoxaparin

• Lovenox is used for preventing deep vein thrombosis after abdominal surgery, or hip or knee replacement surgeries, and in patients with reduced mobility due to illness.
• It is used both in and out of the hospital for treating deep vein thrombosis and pulmonary embolism.
• Lovenox also is used for preventing a second heart attack and related complications after a heart attack and for preventing blood clots in arterial stents.

Common side effect associated with enoxaparin are:

• Bleeding
• Fever
• Nausea
• Diarrhea
• Fluid retention

Other possible side effects include:

• Abnormal liver tests in the blood
• Mild local irritation
• pain
• Local injection site reaction

Possible serious side effects include:

• Liver damage
• A reduction in blood platelets
• Red blood cells (anemia)
• Major bleeding
• Hematoma
• Ecchymosis
• Erythema
• Atrial fibrillation
• Heart failure
• Pulmonary edema
• Hypersensitivity reactions
• Pneumonia
• Osteoporosis
• Skin necrosis
• Increased potassium levels
• Anemia
• Prosthetic heart valve thrombosis

Lovenox is administered by injection under the skin (subcutaneous) or intravenously.

• Preventing deep vein thrombosis after abdominal surgery: 40 mg subcutaneous injection once daily.
• Preventing deep vein thrombosis after knee replacement: 30 mg subcutaneous injection every 12 hours.
• Preventing deep vein thrombosis after hip replacement: 30 mg every 12 hours or 40 mg once daily by subcutaneous injection.
• Preventing deep vein thrombosis in ill patients with limited mobility: 40 mg subcutaneous injection once daily.
• Treatment of deep vein thrombosis or pulmonary embolism: 1 mg/kg every 12 hours or 1.5 mg/kg once daily by subcutaneous injection.
• Outpatient treatment of deep vein thrombosis: 1 mg/kg subcutaneous injection every 12 hours.
• Treatment of severe heart attacks (ST elevation myocardial infarction or STEMI): For patients under the age of 75, 30 mg intravenously plus 1 mg/kg subcutaneously followed by 1 mg/kg every 12 hours (maximum of 100 mg for each of the first two subcutaneous doses only). For patients over age 75, 0.75 mg/kg subcutaneously every 12 hours (maximum of 75 mg for each of the first two subcutaneous doses only). All patients should receive aspirin. Doses should be reduced in patients with impaired kidney function.
• Treatment of chest pain (unstable angina) or mild heart attack (non-Q-wave myocardial infarction): 1 mg/kg subcutaneously every 12 hours with aspirin.
• For coronary artery stent procedures (percutaneous coronary intervention or PCI): Patients should receive 0.3 mg/kg during stent placement if the last dose of Lovenox was administered more than 8 hours before the procedure.

• Medications that increase the risk of bleeding will add to the effects of Lovenox and further increase the risk of bleeding that is associated with Lovenox. Such medications include aspirin, clopidogrel (Plavix), warfarin, other anticoagulants, and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin; Advil), naproxen (Naprosyn), diclofenac (Voltaren), and others.

• Lovenox does not cross the placenta and shows no evidence of effects on the fetus. It often is used during pregnancy as an alternative to oral anticoagulants such as warfarin, which cannot be safely used during pregnancy.
• Lovenox multiple-dose vials contain benzyl alcohol as a preservative. Benzyl alcohol has been associated with a fatal "gasping syndrome" in premature neonates. Lovenox vials preserved with benzyl alcohol should be used with caution in pregnant women and only if clearly needed because benzyl alcohol may cross the placenta.
• It is not known if Lovenox is excreted in breast milk. Since most medicines are excreted in breast milk, it is recommended that women receiving Lovenox should not breastfeed.

What preparations of enoxaparin are available?

• Lovenox is available in pre-filled syringes containing 30, 40, 60, 80, 100, 120, and 150 mg.
• Multiple dose vial: 300 mg

How should I keep enoxaparin stored?

All Lovenox products should be stored at room temperature, between 15 and 30 C (59 and 86 F).