Enoxaparin

Enoxaparin is a prescription medication used to prevent and treat blood clots. It is used to treat hospital patients who are on bed rest, who are about to have surgery, or who have complications from chest pain or heart attacks. Enoxaparin can also be taken at home to prevent blood clots in the legs. 

Enoxaparin belongs to a group of drugs call low molecular weight heparins or "blood thinners". It slows the formation of blood clots. This medication does not break down clots.

Enoxaparin comes in an injectable form to be injected under the skin (subcutaneously) or directly into a vein (IV).

Common side effects of enoxaparin include bleeding, fever, and nausea.

Enoxaparin is a prescription medication used:

• to prevent blood clots in hospital patients who are on bed rest
• to prevent blood clots in hospital patients who are about to have abdominal (stomach), hip, or knee surgery
• in the hospital along with aspirin to prevent complications of chest pain (angina) and heart attack
• in the hospital along with warfarin (Coumadin) to prevent blood clots in the legs with or without a blockage of a lung artery (pulmonary embolism)
• at home along with warfarin (Coumadin) to prevent blood clots in the legs without a blockage of a lung artery (pulmonary embolism)

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Enoxaparin may be found in some form under the following brand names:

• Lovenox

Serious side effects have been reported with enoxaparin. See “Drug Precautions” section.

Common side effects of enoxaparin include:

• bleeding
• fever
• nausea
• diarrhea
• upset stomach
• irritation or burning at the injection site
• low red blood cell count (anemia)
• bruising
• confusion

This is not a complete list of enoxaparin side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• anticoagulants, or blood thinners, such as heparin
• platelet inhibitors, such as clopidogrel (Plavix)
• acetylsalicylic acids, such as aspirin (Ecotrin)
• salicylates, such as Pepto-Bismol
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve)
• ketorolac tromethamine (Toradol)
• dipyridamole (Persantine)
• sulfinpyrazone (Anturane)

This is not a complete list of enoxaparin drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with enoxaparin including:

• Increased risk of bleeding:  Enoxaparin increases your risk of bleeding, and can cause bleeding in the brain, paralysis, and death.  Tell your healthcare provider right away if you have some or all of the following symptoms of bleeding:
  • easy bruising
  • black or bloody stools
  • blood in the urine
  • bloody vomit
  • decrease in blood pressure (hypotension)
• Enoxaparin should be used with caution in some patients.  Tell your doctor if you have a history of:
  • bleeding
  • ulcers
  • hypertension (high blood pressure)
  • kidney disease
  • damage to the retina (retinopathy) from diabetes
  • low platelet counts caused by heparin
• Enoxaparin can cause very low levels of platelets in the blood, medically referred to as thrombocytopenia.  Your doctor may take blood samples to monitor your response to enoxaparin.
• Enoxaparin should be used with caution in pregnant women with artificial heart valves.  Clots could develop and possibly cause death to the pregnant woman and the developing child.
• Enoxaparin can change results of liver tests.  Tell your doctor if you have a history of liver disease.

Do not take enoxaparin if you:

• are actively bleeding
• have a decreased amount of platelets in the blood (thrombocytopenia) when exposed to enoxaparin
• are allergic to enoxaparin, heparin, or pork products

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of enoxaparin, there are no specific foods that you must exclude from your diet when receiving enoxaparin.

Before taking enoxaparin, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• have a history of liver, kidney, or heart disease
• have a history of bleeding, ulcers, or high blood pressure
• have a history of retina damage (retinopathy) caused by diabetes
• have a history of spine problems
• are allergic to enoxaparin, heparin, or pork products
• have a decreased amount of platelets in the blood (thrombocytopenia) when exposed to enoxaparin
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Enoxaparin falls into category B. Studies in animals have failed to demonstrate a risk to the unborn baby, and there are no well-controlled studies in pregnant women.

Tell your doctor if you are breastfeeding or plan to breastfeed.

You should not take enoxaparin if you are breastfeeding. It is not known if enoxaparin is excreted in human breast milk or if it will harm your nursing baby.

You may receive enoxaparin while you are still in the hospital. Your healthcare provider will probably be giving you the injections. In some cases you will receive injections directly into a vein (IV). Before you leave the hospital, your healthcare provider will teach you to give yourself the injections, or he or she may teach someone else to give you the injections. When you are injecting the medication at home, you will be injecting it just under the skin (subcutaneously). Enoxaparin should not be injected into muscle.

To inject enoxaparin, follow these instructions:

1. Wash your hands.

2. Clean the area of skin where you will give the shot.

3. Make sure the drug is clear and colorless or pale yellow. Each syringe has one dose of enoxaparin.

4. Take the cap off the needle. Do not push any air or drug out of the syringe before giving the shot unless your healthcare provider tells you to.

5. While lying down, pinch a fold of skin between your finger and thumb. Inject the medication after pushing the entire needle into the skin and pressing down on the syringe plunger. Release the skin after enoxaparin is injected. Do not rub the area of the injection.

Enoxaparin is usually injected once or twice daily for up to 14 days. 

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of enoxaparin at the same time.

The dose your healthcare provider recommends will depend upon several factors such as:

• your weight
• how well your kidneys function
• the medical condition being treated
• whether you are treating or preventing blood clots
• other medical conditions you have

Take enoxaparin exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

If you take too much enoxaparin or you suspect you are given too much, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Store enoxaparin at room temperature.
• Keep this and all medicines out of the reach of children.

WARNING: SPINAL/EPIDURAL HEMATOMAS

Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:

• Use of indwelling epidural catheters
• Concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants
• A history of traumatic or repeated epidural or spinal punctures
• A history of spinal deformity or spinal surgery

Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.

Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.