Enoxaparin: functions, dosage, side effects, how to use

What Drug Enoxaparin?

What is enoxaparin for?

Enoxaparin is a drug used to prevent and treat life-threatening blood clots. This drug helps reduce the risk of heart attack. These drugs keep blood flow smooth by decreasing the activity of clotting proteins in the blood. Enoxaparin is an anticoagulant, also known as a "blood thinner." This drug is classified as a type of heparin.

Conditions that increase the risk of developing blood clots include certain surgeries (such as knee / hip replacements, and abdominal surgery), prolonged immobilization, heart attacks, and unstable angina. For some medical conditions, enoxaparin may be used in combination with other "blood thinning" drugs.

How should enoxaparin be used?

This medication is given by injection into the skin as directed by your doctor, usually once or twice daily in the abdominal area (at least 5 cm from the navel). Do not inject drugs into muscles. The number of doses and length of treatment are based on your medical condition and your body's response to treatment. Dosage can also be based on age and body weight in certain types of disease. Use this remedy regularly for best results. Just so you remember, use the medicine at the same time every day.

If you are using this medication at home, learn all the preparation and instructions for use from your healthcare professional as well as those listed on the product package. Before using the drug, check this product for particles or discoloration. If the medicine appears to have changed in texture or color, do not use this medication.

Before injecting the drug, first clean the area to be injected using alcohol. Do not inject in the same place to avoid skin damage. To minimize the appearance of swelling on the skin, do not rub the area with the injection. Know how to store and dispose of drug waste safely.

This medication may also be injected intravenously by a healthcare professional, as directed by your doctor.

How is enoxaparin stored?

This medication is best stored at room temperature, away from direct light and damp places. Don't keep it in the bathroom. Don't freeze it. Other brands of this drug may have different storage rules. Observe the storage instructions on the product package or ask your pharmacist. Keep all medicines away from children and pets.

Do not flush medicines down the toilet or down the drain unless instructed to do so. Discard this product when it has expired or when it is no longer needed. Consult your pharmacist or local waste disposal company about how to safely dispose of your product.

Rules for Use of Enoxaparin

The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before starting treatment.

What is the dose of enoxaparin for adults?

Adult Dose for Deep Vein Thrombosis - Prophylaxis:

40 mg injected under the skin once daily for 6 to 11 days. Treatment up to the 14th day is tolerable in clinical trials. In obese patients (BMI 40 kg / m2 or more), increasing the prophylactic dose by 30% may be appropriate.

Adult Dose for Deep Vein Thrombosis:

Outpatient: 1 mg / kg injected under the skin every 12 hours.

Hospitalization: 1 mg / kg injected under the skin every 12 hours or 1.5 mg / kg subcutaneously once a day at the same time each day. In outpatient and inpatient care, warfarin sodium therapy should be started on the same day that enoxaparin was started. Enoxaparin should be continued for at least 5 days and until the anticoagulant therapeutic effect is successful (INR 2.0-3.0). The duration of treatment is usually 7 days; until the 17th day still tolerable in controlled clinical trials.

Obesity: Dose is calculated based on body weight; discontinuation of the dose is not recommended; The use of the dosage twice a day is recommended.

Adult Dose for Myocardial Infarction:

Unstable angina and non-Q wave myocardial infarction:

1 mg / kg injected under the skin every 12 hours in conjunction with oral aspirin therapy (100-325 mg once daily). Obesity: Dose is calculated based on body weight; discontinuation of the dose is not recommended. Treatment should be given for at least 2 days and continue until the health condition stabilizes. Vascular sheath access for drug instrumentation should be maintained for 6-8 hours after taking the enoxaparin dose. The next scheduled dose should be given no less than 6-8 hours after removal of the sheath. The duration of treatment is generally 2-8 days; treatment up to day 12.5 is well tolerated in clinical trials.

ST segment acute myocardial infarction elevation:

A single 30 mg intravenous bolus plus 1 mg / kg injected under the skin (subcutaneously) kg followed by 1 mg / kg injected under the skin every 12 hours (maximum 100 mg for the first two doses only, followed by 1 mg / kg for the dose the remaining).

Obesity:

Dosage is calculated based on body weight; a maximum dose of 100 mg is recommended for the first 2 doses. When given concurrently with thrombolytics, enoxaparin should be given between 15 minutes before and 30 minutes after starting fibrinolytic treatment. All patients should be given oral aspirin therapy of 75-325 mg once daily (unless contraindicated). The optimal duration of treatment is uncertain, possibly more than 8 days. Patients receiving thrombolytics, use enoxaparin between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients undergoing treatment by PCI, if the last subcutaneous dose of enoxaparin was less than 8 hours before balloon inflation, no additional dose is required. If the last subcutaneous dose was administered more than 8 hours before balloon inflation, the patient should be given an intravenous bolus of 0.3 mg / kg.

Usual Adult Dose for Angina Pectoris:

Unstable angina and non-Q wave myocardial infarction:

1 mg / kg injected under the skin every 12 hours in conjunction with oral aspirin therapy (100-325 mg once daily).

Obesity:

Use actual body weight to calculate doses; capping doses are not recommended. Treatment should be given for at least 2 days and continue until the health condition stabilizes. Vascular sheath access for drug instrumentation should be maintained for 6-8 hours after enoxaparin use. The next scheduled dose should be given no later than 6-8 hours after removal of the sheath. Duration of treatment is usually 2-8 days; treatment up to day 12.5 is still well tolerated in clinical trials.

ST segment acute myocardial infarction elevation:

A single 30 mg intravenous bolus plus 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 dose).

Obesity:

Use a dosage based on body weight; a maximum dose of 100 mg is recommended for the first 2 doses. When given concurrently with thrombolytics, enoxaparin should be given between 15 minutes before and 30 minutes after starting fibrinolytic treatment. All patients should be given oral aspirin therapy (75-325 mg once daily unless contraindicated). The duration of treatment is uncertain, possibly more than 8 days. In patients receiving thrombolytics, use a dose of enoxaparin between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients undergoing treatment by PCI, if the last subcutaneous enoxaparin dose was less than 8 hours before balloon inflation, there is no need to use the drug again. If the last subcutaneous dose was administered more than 8 hours before balloon inflation, the patient will need to be given an intravenous bolus of 0.3 mg / kg.

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 (100-325 mg once daily).

Obesity:

The dose is calculated based on body weight, it is not recommended to stop using the dose. Treatment should be given for at least 2 days and continue until the health condition stabilizes. Vascular sheath access for drug instrumentation should be maintained for 6-8 hours after enoxaparin use. The use of the next dose should not be more than 6-8 hours after removing the sheath. Duration of treatment is usually 2-8 days; day 12.5 is well tolerated in clinical trials.

ST segment acute myocardial infarction elevation:

A single 30 mg intravenous bolus plus 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 dose). Obesity: Dosage is based on body weight; a maximum dose of 100 mg is recommended for the first 2 doses. When given concurrently with thrombolytics, enoxaparin should be given between 15 minutes before and 30 minutes after starting fibrinolytic treatment. All patients should be given oral aspirin therapy (75-325 mg once daily unless contraindicated). The optimal duration of treatment has yet to be determined, possibly more than 8 days. Patients receiving thrombolytics, use enoxaparin between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients undergoing treatment with PCI, if the last subcutaneous enoxaparin dose was less than 8 hours before balloon inflation, the patient did not need an additional dose. If the last subcutaneous dose was administered more than 8 hours before balloon inflation, the patient should be given an intravenous bolus of 0.3 mg / kg.

Usual Adult Dose for Prophylactic Deep Vein Thrombosis after Hip Replacement Surgery

30 mg subcutaneously every 12 hours. Provided that hemostasis has been determined, the initial dose should be given 12-24 hours after surgery. For hip replacement surgery, a once-daily subcutaneous dose of 40 mg given 12 hours before surgery can be considered. After the initial stages of thromboprophylaxis in hip replacement surgery patients, continue to use prophylaxis with 40 mg subcutaneously once daily for 3 weeks. The duration of treatment is usually 7 to 10 days; up to 14 days is tolerable in clinical trials.
In obese patients (BMI 40 kg / m2 or more), increasing the prophylactic dose by 30% is likely to be successful.

Usual Adult Dose for Prophylactic Deep Vein Thrombosis after Knee Replacement Surgery:

30 mg subcutaneously every 12 hours. Provided that hemostasis is determined, the initial dose should be given 12-24 hours after surgery. For knee replacement surgery, patients may be given a dose of 40 mg subcutaneously once daily given 12 hours before surgery. After the initial stage of thromboprophylaxis in knee replacement surgery patients, it is recommended to continue using prophylaxis with 40 mg subcutaneously once a day for 3 weeks. The duration of treatment is usually between 7-10 days; treatment up to day 14 is well tolerated in clinical trials.
In obese patients (BMI 40 kg / m2 or more), increasing the prophylactic dose by 30% is likely to be successful.

Usual Adult Dose for Prophylactic Deep Vein Thrombosis after Abdominal Surgery:

40 mg subcutaneously once daily with the initial dose given 2 hours before surgery. The duration of treatment is usually between 7-10 days; treatment up to day 12 is well tolerated in clinical trials.

Bariatric surgery:

Roux en Y in the stomach: there are no clear instructions for using the dosage of the drug. BMI less than or equal to 50 kg / m2: 40 mg subcutaneously every 12 hours. BMI greater than 50 kg / m2: 60 mg subcutaneously every 12 hours.

Geriatric Dosage for Myocardial Infarction:

ST segment acute myocardial infarction elevation:

Patients over 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 the first two doses only, followed by 0.75 mg / kg for the remaining doses).

What is the dose of enoxaparin for children?

Pediatric Dose for Deep Vein Thrombosis - Prophylaxis:

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.

Pediatric Dose for Deep Vein Thrombosis:

Less than 2 months: 1.5 mg / kg subcutaneously every 12 hours. 2 months to 17 years: 1 mg / kg subcutaneously every 12 hours.

Alternative dosage:

Note: Recent studies recommend the use of higher than recommended doses (especially in preterm neonates, neonates, and young infants). Several research centers use the following doses, although further research is needed to validate the proposed use of these higher doses.

Premature babies: 2 mg / kg / dose every 12 hours

Neonates: 1.7 mg / kg / dose every 12 hours

Infants younger than 3 months: 1.8 mg / kg / dose every 12 hours

3 to 12 months: 1.5 mg / kg / dose every 12 hours

1 to 5 years: 1.2 mg / kg / dose every 12 hours

6 to 18 years: 1.1 mg / kg / dose every 12 hours

In what dosage is enoxaparin available?

Solution, injection, sodium: 300 mg / 3 mL.

Solution, subcutaneous, sodium: 30 mg / 0.3 mL, 40 mg / 0.4 mL, 60 mg / 0.6 mL, 80 mg / 0.8 mL, 100 mg / mL, 120 mg / 0.8 mL , 150 mg / mL.

Enoxaparin dosage

What side effects can be experienced due to enoxaparin?

Seek immediate medical help if you experience any of the following signs of an allergic reaction: hives, difficulty breathing, swelling of the face, lips, tongue, or throat.

Stop using enoxaparin and call your doctor right away if you have serious side effects such as:

• abnormal bleeding (from the nose, mouth, vagina, or anus), bleeding from a needle injection, and bleeding that is difficult to stop
• appear red or purplish spots on the skin
• pale skin, feeling dizzy or short of breath, rapid heart rate, difficulty concentrating
• black or bloody stools, coughing up blood or vomiting that looks like coffee grounds
• numbness, tingling, or muscle weakness (especially in the legs)
• loss of motor skills in one part of the body
• sudden weakness, headache, confusion, or speech problems, vision problems, or balance problems
• difficulty breathing

Less serious side effects include:

• nausea, diarrhea
• fever
• swelling in the hands or feet
• mild pain, irritation, redness, or swelling at the injection site

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about the side effects caused by using the drug, please consult your doctor or pharmacist.

Enoxaparin side effects

What should be known before using enoxaparin?

Before getting enoxaparin treatment, contact your doctor and pharmacist if you are allergic to enoxaparin, heparin, other drugs, or pork products.

Tell your doctor and pharmacist about all medications, either on or without a prescription, especially those listed in the IMPORTANT WARNING section and the vitamins you are taking.

Tell your doctor if you have an artificial heart valve and if you have or have ever had kidney disease, heart infection, stroke, bleeding disorders, ulcers, or decreased platelet count.

Call your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. If you become pregnant while using enoxaparin, call your doctor.

If you are having surgery, including dental surgery, tell your doctor or dentist that you are taking enoxaparin.

Is enoxaparin safe for pregnant and lactating women?

There are no adequate studies regarding the risks of using this drug in pregnant or breastfeeding women. Always consult your doctor to weigh the potential benefits and risks before using this medication. This drug is included in the risk of pregnancy category B according to the US Food and Drug Administration (FDA).

The following references the pregnancy risk categories according to the FDA:

• A = No risk,
• B = not at risk in several studies,
• C = May be risky,
• D = There is positive evidence of risk,
• X = Contraindicated,
• N = Unknown

There are not sufficient studies in women to find out the risk to the baby when the mother takes this drug during breastfeeding. Consider the potential benefits and potential risks before taking this medication during breastfeeding.

Enoxaparin Drug Warnings and Cautions

What medicines may interact with enoxaparin?

Tell your doctor about all medicines you use, including those you start using or stop using enoxaparin, as well as any other medicines used to treat or prevent blood clots, such as:

• abciximab, anagrelide, cilostazol, clopidogrel, dipyridamole, eptifibatide, ticlopidine, tirofiban
• alteplase, reteplase, tenecteplase, urokinase
• apixaban, argatroban, bivalirudin, dabigatran, desirudin, fondaparinux, lepirudin, rivaroxaban, tinzaparin
• heparin

This list is not exhaustive. Other drugs can interact with enoxaparin, including prescription and nonprescription drugs, vitamins, and herbal products. Not all possible interactions are listed in the medication guide.

Can food or alcohol interact with enoxaparin?

Certain drugs should not be used with meals or when eating certain foods because drug interactions can occur. Consuming alcohol or tobacco with certain drugs can also cause interactions to occur. Discuss your use of drugs with food, alcohol, or tobacco with your health care provider.

What health conditions can interact with enoxaparin?

The presence of other medical problems can affect the use of this drug. Make sure you tell your doctor if you have other medical problems, especially:

• blood disease or bleeding
• blood vessel problems
• insertion of a catheter tube into the spine
• diabetic retinopathy (eye problems)
• heart infection
• heart valve problems, prosthetics
• hypertension (high blood pressure), which is uncontrollable
• septic shock
• gastric or intestinal ulcer or bleeding, active
• stroke, or have had
• surgery (for example on the eyes, brain, or spine), recently had surgery or has had surgery
• thrombocytopenia, induced heparin, or have had
• threatened with miscarriage
• weighing less than 44 kg (women) or 57 kg (men). Use with caution because the risk of bleeding can increase
• large, active bleeding
• thrombocytopenia (low platelet count in the blood). Should not be used in patients with this condition
• kidney disease - use with caution. Side effects can increase because the process of cleansing the drug is slower in the body.

Enoxaparin Drug Interactions

What should I do in an emergency or overdose?

In case of an emergency or overdose, contact the local emergency services provider (112) or immediately to the nearest hospital emergency department.

What should I do if I miss a dose?

If you forget a dose of this medicine, take it as soon as possible. However, when it is nearing the time of the next dose, skip the missed dose and return to the usual dosing schedule. Don't double the dose.

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