Enoxaparin

Introduction

• Generic Name: Enoxaparin
• Brand Names: Lovenox, Clexane
• Pharmacological Class: Low molecular weight heparin (LMWH)
• Mechanism of Action: Acts by enhancing the inhibition of Factor Xa and thrombin, reducing the ability of blood to clot.

Indications

• Primary Use: Prevention of deep vein thrombosis (DVT), which can lead to pulmonary embolism in patients undergoing abdominal surgery, hip or knee replacement surgery, or those with reduced mobility during acute illness.
• Other Uses: Treatment of existing DVT with or without pulmonary embolism, and prevention of complications in patients with unstable angina and non-Q-wave myocardial infarction.

Dosage

• Adults: Dosage varies based on condition treated; for DVT prevention post-surgery, typically 40 mg once daily subcutaneously. For treatment, 1 mg/kg every 12 hours or 1.5 mg/kg once daily.
• Elderly: No dosage adjustments are necessary unless renal function is impaired.
• Children: Safety and efficacy have not been fully established for all indications.

Administration

• Method: Subcutaneous injection.
• Precautions: Rotate injection sites daily to prevent bruising. Do not inject intramuscularly.

Forms Available

• Pre-filled Syringes: 20 mg/0.2 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL
• Multi-dose Vials: 300 mg/3 mL

Side Effects

• Common: Bleeding, injection site reactions, mild pain or bruising.
• Less Common: Anemia, thrombocytopenia.
• Rare but Serious: Severe bleeding, heparin-induced thrombocytopenia, osteoporosis with long-term use.

Warnings

• Contraindications: Active major bleeding, thrombocytopenia associated with a positive test for antiplatelet antibody in the presence of enoxaparin, hypersensitivity to enoxaparin or heparin.
• Black Box Warning: Epidural or spinal hematomas may occur with the concurrent use of enoxaparin and spinal/epidural anesthesia or spinal puncture, which can result in long-term or permanent paralysis.

Precautions

• General: Monitor for signs of neurological impairment, which may precede bleeding.
• Health Conditions: Use with caution in conditions with increased risk of hemorrhage. Monitor platelet counts closely.

Interactions

• Medications: Increased risk of bleeding with anticoagulants, antiplatelet agents, and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Food: No significant food interactions.

Monitoring Parameters

• Hemoglobin and Hematocrit: Monitor for decreases indicating bleeding.
• Platelet Count: Monitor regularly to detect heparin-induced thrombocytopenia.
• Renal Function: Assess renal function periodically, especially in the elderly or those with renal impairment.

Use in Children

• Guidelines: Dosage must be carefully adjusted according to body weight and indication.

Use in Pregnancy

• FDA Category: B. No evidence of risk in human studies; however, should be used during pregnancy only if clearly needed.

Use in Elderly

• Considerations: Increased risk of bleeding; dose adjustments may be needed based on renal function.

Use in Kidney Disease

• Adjustments: Dose reduction required in patients with renal impairment to prevent accumulation and increased bleeding risk.

Use in Liver Disease

• Caution: Use with caution; may require dose adjustments or increased monitoring for bleeding.

Patient Counselling Points

• Medication Use: Ensure proper technique for subcutaneous administration and importance of adherence to dosing schedule.
• Side Effects: Report any unusual bruising, bleeding, or signs of thrombocytopenia (such as a rash of purple spots).
• Lifestyle: Avoid activities with a high risk of bleeding or injury.

Table of Brand Names, Manufacturer, and Prices in USD

Brand Name	Manufacturer	Strength/Dosage Form	Price (USD)
Lovenox	Sanofi	40 mg/0.4 mL Syringe	$100.00
Clexane	Sanofi	20 mg/0.2 mL Syringe	$50.00

15 FAQs with Answers

1. What is Enoxaparin used for? – Primarily for the prevention and treatment of DVT and pulmonary embolism.
2. Can Enoxaparin cause bleeding? – Yes, bleeding is the most common side effect.
3. How is Enoxaparin administered? – Via subcutaneous injection.
4. What should I avoid while taking Enoxaparin? – Avoid activities that increase the risk of bleeding.
5. Is Enoxaparin safe during pregnancy? – Classified as Category B, considered safe but use only if necessary.
6. Can Enoxaparin be used with other anticoagulants? – Caution is needed due to increased bleeding risk.
7. What are signs of overdose with Enoxaparin? – Overdose can increase the risk of serious bleeding.
8. Is Enoxaparin safe for children? – Dosages must be carefully adjusted, not fully established for all uses.
9. What are the rare but serious side effects of Enoxaparin? – Severe bleeding, spinal/epidural hematoma.
10. How should I store Enoxaparin? – Store in its original package at room temperature, away from light.
11. Can Enoxaparin affect platelet counts? – Yes, it can cause thrombocytopenia.
12. What monitoring is required with Enoxaparin? – Regular monitoring of platelet counts, hemoglobin, and renal function.
13. What precautions should I take with Enoxaparin? – Monitor for signs of bleeding and neurological changes.
14. Who should not take Enoxaparin? – Those with active major bleeding or severe hypersensitivity to its components.
15. How does Enoxaparin work to prevent blood clots? – It inhibits key factors involved in the blood clotting process.