Lovenox

Lovenox (Enoxaparin) is injected under the skin (subcutaneously, not intramuscularly).

The recommended dose varies according to the individual and the condition being treated.

For acute-ST-segment elevation heart attacks, you will receive a single dose of 30 mg of Lovenox (Enoxaparin) injected into a vein. Subsequent doses are injected subcutaneously every 12 hours, and are calculated as 1 mg per kilogram of body weight. This is usually continued for 8 days or until release from the hospital.

For the treatment of unstable angina or Non-Q-Wave heart attacks, the dose is calculated as 1 mg per kilogram of body weight, injected subcutaneously every 12 hours. To treat deep vein thrombosis (DVT), the recommended dose is 1.5 mg per kilogram of body weight, injected subcutaneously once daily or 1 mg per kilogram of body weight, injected subcutaneously every 12 hours.

If Lovenox (Enoxaparin) is being used to prevent blood clots when you are having knee or hip replacement surgery, the recommended dose is 30 mg injected subcutaneously every 12 hours, starting 12 to 24 hours after surgery. This is usually used for 7 to 14 days.

To prevent blood clots caused by abdominal, colorectal, gynecological, or urological surgery, the recommended dose is 40 mg injected subcutaneously 2 hours before surgery and continuing once daily for 7 to 10 days. If there is no risk of bleeding, but high risk of developing blood clots, this dose may be continued for up to 4 weeks.

To prevent blood clots caused by other medical conditions, such as when you have an illness and have limited ability to move about, the recommended dose is 40 mg injected subcutaneously, once daily. The use of Lovenox (Enoxaparin) in these situations is usually short-term (6 to 11 days).

Steps to use the medication:

1. Before injecting Lovenox (Enoxaparin), wash your hands and clean the area of skin where you will inject with an alcohol swab. Do not rub the area to be injected. Only use the injection if the solution appears clear and colourless or pale yellow.
2. Lie down and pinch a fold of skin (usually in the lower abdomen at least 5 cm away from your belly button and out towards the sides) between your finger and thumb. Choose a different place of the lower abdomen for each injection.
3. Remove the needle cover by pulling it straight off the syringe.
4. Push the entire needle vertically into the skin in one smooth quick motion, and then press down on the syringe plunger to inject the medication. Make sure you are holding the skin fold the entire time you are injecting the needle and pressing down on the syringe plunger.
5. After giving the injection, remove the needle from your skin. A protective sleeve will automatically cover the needle. Use an alcohol swab to apply light pressure to the injection area for several seconds. Do not rub the site afterwards.
6. Dispose of the syringe and needle safely (using a sharps container). Each syringe is for single use only.

To prevent clot formation during hemodialysis, the dose varies depending on your circumstances and the medication will be given by injection into the tubing that carries your blood to the dialysis machine.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using Lovenox (Enoxaparin) without consulting your doctor.

It is important to use Lovenox (Enoxaparin) exactly as prescribed by your doctor. If you miss an injection, take it as soon as possible and continue with your regular schedule. If it is almost time for your next injection, skip the missed dose and continue with your regular dosing schedule. Do not inject a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Lovenox (Enoxaparin) at room temperature, protect it from heat, and keep it out of the reach of children. If you are using the multiple dose vial, do not store it for more than 28 days after the first use.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause pain; it may reduce your blood clotting ability; it may cause redness and swelling at the injection site. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Multidose Vials

Each multidose vial contains 300 mg of Lovenox (Enoxaparin) sodium in 3 mL of water for injection (concentration 10 mg/0.1 mL) and 1.5% (m/v) benzyl alcohol as a preservative.

Prefilled Syringes

30 mg/0.3 mL
Each syringe contains 30 mg of Lovenox (Enoxaparin) sodium in 0.3 mL of water for injection. The solution is preservative-free and intended for use as a single-dose injection.

40 mg/0.4 mL
Each syringe contains 40 mg of Lovenox (Enoxaparin) sodium in 0.4 mL of water for injection. The solution is preservative-free and intended for use as a single-dose injection.

60 mg/0.6 mL
Each syringe contains 60 mg of Lovenox (Enoxaparin) sodium in 0.6 mL of water for injection. The solution is preservative-free and intended for use as a single-dose injection.

80 mg/0.8 mL
Each syringe contains 80 mg of Lovenox (Enoxaparin) sodium in 0.8 mL of water for injection. The solution is preservative-free and intended for use as a single-dose injection.

100 mg/1 mL
Each syringe contains 100 mg of Lovenox (Enoxaparin) sodium in 1 mL of water for injection. The solution is preservative-free and intended for use as a single-dose injection.

The 60 mg/0.6 mL, 80 mg/0.8 mL, and the 100 mg/1 mL syringes are imprinted with a graduation scale of 1 mL with major increments of 0.1 mL and minor increments of 0.025 mL.

Each Lovenox® presentation has a solution pH of 5.5 to 7.5 with an approximate anti-factor Xa activity of 100 IU/1 mg of drug (with reference to the WHO First International Low Molecular Weight Heparin Reference Standard).

Do not use Lovenox (Enoxaparin) if you:

• are allergic to Lovenox (Enoxaparin) or any ingredients of the medication
• are allergic to other low molecular weight heparins or heparin
• are actively bleeding
• are receiving spinal or epidural anesthesia and will be needing multiple doses of Lovenox (Enoxaparin)
• currently have or have previously had a history of heparin-induced thrombocytopenia (decrease in the number of platelets) or a positive in vitro platelet-aggregation test while using Lovenox (Enoxaparin)
• have decreased platelets
• have a hemorrhagic cerebrovascular accident (bleeding into tissues of the brain)
• have acute or sub-acute bacterial Endocarditis (heart infection)
• have an active gastric (stomach) or duodenal (intestinal) ulcer
• have eye problems due to Diabetes or hemorrhage (bleeding)
• have injuries to and operations on the brain, spinal cord, eyes, or ears
• have major blood clotting disorders
• have other conditions or diseases involving an increased risk of bleeding
• have severe uncontrolled high blood pressure

People who need repeated doses of Lovenox (Enoxaparin) should not receive anesthetics that are injected into the spine or epidural space.

There may be an interaction between Lovenox (Enoxaparin) and any of the following:

• 5-ASA medications (e.g., Mesalamine, Olsalazine, Sulfasalazine)
• acetylsalicylic acid (ASA)
• Aliskiren
• angiotensin converting enzyme inhibitors (ACEIs; Captopril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., Candesartan, Irbesartan, Losartan)
• Apixaban
• Canagliflozin
• Clopidogrel
• dabigatran
• Dasatinib
• Deferasirox
• deoxycholic acid
• Dipyridamole
• Edoxaban
• Eplerenone
• estrogens (e.g., conjugated estrogen, Estradiol, ethinyl estradiol)
• heparin
• herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, turmeric)
• mifepristone
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., Diclofenac, ibuprofen, naproxen)
• Obinutuzumab
• omega-3 fatty acids
• other low-molecular-weight heparins (e.g., Dalteparin, Tinzaparin)
• Pentoxifylline
• potassium-sparing diuretics (e.g., Amiloride, Spironolactone, triamterene)
• potassium supplements (e.g., potassium chloride, potassium citrate)
• progestins (e.g., Dienogest, Levonorgestrel, medroxyprogesterone, Norethindrone)
• Rivaroxaban
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin-norepinephrine reuptake inhibitors (SNRIs; Desvenlafaxine, Duloxetine, Venlafaxine)
• thrombolytic agents (e.g., alteplase, streptokinase, urokinase)
• Ticagrelor
• Ticlopidine
• vitamin E
• vorapaxar
• Warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Lovenox (Enoxaparin). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Lovenox (Enoxaparin).

Bleeding: The most serious risk associated with Lovenox (Enoxaparin) is bleeding in any tissue or organ. It is extremely important to have regular blood tests (as prescribed by your doctor) to ensure that the correct level of blood thinning is occurring. People with an increased risk of bleeding (such as seniors) should be closely monitored by their doctors while taking Lovenox (Enoxaparin). If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible.

Body weight: The safety and efficacy of Lovenox (Enoxaparin) for people of high weight (e.g., over 120 kg) and low weight (e.g., under 45 kg) have not been fully established. If you have a high or low weight, discuss with your doctor how Lovenox (Enoxaparin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Lovenox (Enoxaparin), and whether any special monitoring is needed.

Kidney problems: Decreased kidney function or Kidney Disease can cause Lovenox (Enoxaparin) to build up in the body, causing increased side effects. If you have kidney problems, discuss with your doctor how Lovenox (Enoxaparin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Lovenox (Enoxaparin), and whether any special monitoring is needed.

Liver problems: If you have liver problems, discuss with your doctor how Lovenox (Enoxaparin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Lovenox (Enoxaparin), and whether any special monitoring is needed.

Medical conditions: If you have malignant disease; a history of thrombophilia and known deficiency in antithrombin III, protein C or protein S, or APC resistance; are bedridden due to infections with septic shock; severe COPD (Chronic Obstructive Pulmonary Disease) complicated by right heart failure, discuss with your doctor how Lovenox (Enoxaparin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Lovenox (Enoxaparin), and whether any special monitoring is needed.

Osteoporosis: Prolonged use of Lovenox (Enoxaparin) (i.e., longer than 3 months) has been associated with the development of osteoporosis. If you have osteoporosis or are at risk for developing osteoporosis, discuss with your doctor how Lovenox (Enoxaparin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Lovenox (Enoxaparin), and whether any special monitoring is needed.

Platelets: Platelets are blood cells that cause blood to clot. While you are taking Lovenox (Enoxaparin), your doctor will also be monitoring your platelet count. If your platelet level drops very suddenly, you may have to stop Lovenox (Enoxaparin) and switch to another type of medication. Make sure to tell your doctor if you have had any problems with low platelets or platelet defects in the past.

Prosthetic heart valves: There have been reports of people with prosthetic heart valves who developed clots in their valves when treated with low molecular weight heparin medications, like Lovenox (Enoxaparin). Your doctor will need to monitor you closely while you are taking Lovenox (Enoxaparin).

Spinal/epidural hematomas (a collection of blood, usually clotted): There have been cases of spinal bleeding and blood clots when Lovenox (Enoxaparin) is used along with spinal or epidural anesthesia. These spinal blood clots may lead to long-term or permanent paralysis. The risk is greater with higher treatment doses of Lovenox (Enoxaparin) than with DVT prevention doses and if people are taking other medications that affect blood clotting (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs] such as Naproxen or Ibuprofen). If you notice a sudden inability to move your body or sudden back pain or tenderness, get medical help immediately.

People who need repeated doses of Lovenox (Enoxaparin) should not receive anesthetics that are injected into the spine or epidural space.

Stomach or intestinal ulcers: If you have stomach or intestinal ulcers, discuss with your doctor how Lovenox (Enoxaparin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Lovenox (Enoxaparin), and whether any special monitoring is needed.

Pregnancy: Lovenox (Enoxaparin) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Lovenox (Enoxaparin), contact your doctor immediately.

If you do use Lovenox (Enoxaparin) while you are pregnant, your doctor will need to closely monitor you because of an increased risk of bleeding. Pregnant women should not use Lovenox (Enoxaparin) from multidose vials that contain benzyl alcohol as a preservative. Benzyl alcohol crosses the placenta and can cause a potentially fatal gasping syndrome in premature or newborn babies. Pregnant women who have artificial heart valves will also need to be closely monitored by their doctors if they use Lovenox (Enoxaparin) because of a higher risk of developing clots in their heart valves.

Breast-feeding: It is not known if Lovenox (Enoxaparin) passes into breast milk. If you are a breast-feeding mother and are taking Lovenox (Enoxaparin), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Lovenox (Enoxaparin) have not been established for children.

Seniors: Seniors may be at an increased risk of bleeding while using Lovenox (Enoxaparin). Your doctor may adjust your dose, especially if you weigh less than 45 kg or have decreased kidney function.

This product thins the blood and prevents blockage of blood vessels. It belongs to the family of low-molecular weight heparins.<br/><br/>It must be injected under the skin (subcutaneously) in the abdominal region, according to the technique you were shown. Be sure to choose a different injection site each time.<br/><br/>WARNING: If you injure yourself, prolonged bleeding may occur. Report any excessive or unusual bleeding to your doctor. To reduce the risk of bleeding, do not consume alcohol, make any significant dietary changes, or take acetylsalicylic acid (ASA, e.g., Aspirin) unless prescribed by your doctor.