Generic Name: enoxaparin (ee nox AP a rin)
Brand names: Lovenox, Lovenox HP, Clexane, Clexane Forte
What is enoxaparin?
Enoxaparin is an anticoagulant (blood thinner) that prevents the formation of blood clots.
Enoxaparin is used to treat or prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery, or in people who are bed-ridden due to a prolonged illness.
Enoxaparin is also used to prevent blood vessel complications in people with certain types of angina (chest pain) or heart attack.
Enoxaparin may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about enoxaparin?
You should not use this medication if you are allergic to enoxaparin, heparin, benzyl alcohol, or pork products, or if you have active bleeding, or a low level of platelets in your blood after testing positive for a certain antibody while using enoxaparin.
Enoxaparin may cause you to bleed more easily, especially if you have: a bleeding disorder, hemorrhagic stroke, an infection in the lining of your heart, stomach or intestinal bleeding or ulcer, or if you have had recent brain, spine, or eye surgery.
Enoxaparin can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, a history of spinal surgery or repeated spinal taps, or if you are using other medications to treat or prevent blood clots. Symptoms of this type of blood clot include numbness, tingling, muscle weakness, or loss of movement. Tell any doctor who treats you that you are using enoxaparin. Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding or life-threatening blood clots, and it is very important to tell your doctor about all medicines you have recently used.
Blood clots around the brain or spinal cord may occur if you use enoxaparin with other drugs that can affect blood clotting, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin, and any other medications to treat or prevent blood clots.
Tell your caregivers at once if you have signs of bleeding such as black or bloody stools, coughing up blood, confusion, feeling like you might pass out, or any bleeding that will not stop.
What should I discuss with my healthcare provider before using enoxaparin?
You should not use this medication if you are allergic to enoxaparin, heparin, benzyl alcohol, or pork products, or if you have:
active or uncontrolled bleeding; or
a low level of platelets in your blood after testing positive for a certain antibody while using enoxaparin.
Enoxaparin may cause you to bleed more easily, especially if you have:
a bleeding disorder that is inherited or caused by disease;
hemorrhagic stroke;
an infection of the lining of your heart (also called bacterial endocarditis);
stomach or intestinal bleeding or ulcer; or
recent brain, spine, or eye surgery.
Enoxaparin can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if you have:
a genetic spinal defect;
a history of spinal surgery or repeated spinal taps; or
if you are using other medications to treat or prevent blood clots.
If you have any of these other conditions, you may need an enoxaparin dose adjustment or special tests:
- kidney or liver disease;
uncontrolled high blood pressure;
eye problems caused by diabetes;
recent stomach ulcer; or
if you have ever had low blood platelets after receiving heparin.
FDA pregnancy category B. Enoxaparin is not expected to harm an unborn baby. However, some forms of this medication contain a preservative that may be harmful to a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment. If you use this medication during pregnancy, make sure your doctor knows if you have a mechanical heart valve. It is not known whether enoxaparin passes into breast milk or if it could harm a nursing baby. Do not receive this medication without telling your doctor if you are breast-feeding a baby.
How should I use enoxaparin?
Enoxaparin is injected under the skin or into a vein through an IV. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.
You should be sitting or lying down during the injection. Do not inject enoxaparin into a muscle.
Use a different place on your stomach each time you give an injection under the skin. Your care provider will show you the best places on your body to inject the medication. Do not inject into the same place two times in a row.
Prepare your dose in a syringe only when you are ready to give yourself an injection. Do not mix enoxaparin with other medications in the same IV. Do not use the medication if it has changed colors or has particles in it. Call your doctor for a new prescription.
Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.
Enoxaparin is usually given every day until your bleeding condition improves. Follow your doctor's instructions.
To be sure this medication is not causing harmful effects, your blood and your stool (bowel movement) may need to be tested often. Your nerve and muscle function may also need to be tested. Visit your doctor regularly.
Tell any doctor who treats you that you are using enoxaparin. If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using this medication. Store enoxaparin vials (bottles) at room temperature away from moisture and heat. Once you have used a vial for the first time, the medicine will keep at room temperature for up to 28 days. Throw away the vial after 28 days have passed since you first used the vial, even if there is still medicine left in it.
What happens if I miss a dose?
Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose may cause excessive bleeding.
What should I avoid while using enoxaparin?
Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.
Enoxaparin side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; itching or burning skin; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using enoxaparin and call your doctor at once if you have a serious side effect such as:
unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;
easy bruising, purple or red pinpoint spots under your skin;
pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;
black or bloody stools, coughing up blood or vomit that looks like coffee grounds;
numbness, tingling, or muscle weakness (especially in your legs and feet);
loss of movement in any part of your body;
sudden weakness, severe headache, confusion, or problems with speech, vision, or balance; or
trouble breathing.
Less serious side effects may include:
nausea, diarrhea;
fever;
swelling in your hands or feet; or
mild pain, irritation, redness, or swelling where the medicine was injected.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Enoxaparin Dosing Information
Usual Adult Dose for Deep Vein Thrombosis -- Prophylaxis:
40 mg subcutaneously once a day. The usual duration of administration is 6 to 11 days; up to 14 days administration has been well tolerated in clinical trials.
In morbidly obese patients (BMI of 40 kg/m2 or greater), increasing the prophylactic dose by 30% may be appropriate.
Usual Adult Dose for Deep Vein Thrombosis:
Outpatient: 1 mg/kg subcutaneously every 12 hours
Inpatient: 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg subcutaneously once a day at the same time every day. In both outpatient and inpatient treatments, warfarin sodium therapy should be initiated on the same day of starting enoxaparin. Enoxaparin should be continued for a minimum of 5 days and until a therapeutic oral anticoagulant effect has been achieved (INR 2.0 to 3.0). The average duration of administration is 7 days; up to 17 days of has been well tolerated in controlled clinical trials.
Obesity: Use actual body weight to calculate dose; dose capping not recommended; use of twice daily dosing preferred.
Usual Adult Dose for Myocardial Infarction:
Unstable angina and non Q wave myocardial infarction:
1 mg/kg subcutaneously every 12 hours in conjunction with oral aspirin therapy (100 to 325 mg once daily).
Obesity: Use actual body weight to calculate dose; dose capping not recommended.
Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.
Acute ST segment elevation myocardial infarction:
A single 30 mg intravenous bolus plus a 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 doses).
Obesity: Use weight based dosing; a maximum dose of 100 mg is recommended for the first 2 doses.
When given in conjunction with a thrombolytic, enoxaparin should be given between 15 minutes prior and 30 minutes after the start of fibrinolytic treatment. All patients should be given oral aspirin therapy (75 to 325 mg once daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. In patients receiving thrombolytics, initiate enoxaparin dosing between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients managed by PCI, if the last subcutaneous dose of enoxaparin was less than 8 hours before balloon inflation, no additional dosing is required. If the last subcutaneous dose was given more than 8 hours before balloon inflation, an intravenous bolus of 0.3 mg/kg should be given.
Usual Adult Dose for Angina Pectoris:
Unstable angina and non Q wave myocardial infarction:
1 mg/kg subcutaneously every 12 hours in conjunction with oral aspirin therapy (100 to 325 mg once daily).
Obesity: Use actual body weight to calculate dose; dose capping not recommended.
Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.
Acute ST segment elevation myocardial infarction:
A single 30 mg intravenous bolus plus a 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 doses).
Obesity: Use weight based dosing; a maximum dose of 100 mg is recommended for the first 2 doses.
When given in conjunction with a thrombolytic, enoxaparin should be given between 15 minutes prior and 30 minutes after the start of fibrinolytic treatment. All patients should be given oral aspirin therapy (75 to 325 mg once daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. In patients receiving thrombolytics, initiate enoxaparin dosing between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients managed by PCI, if the last subcutaneous dose of enoxaparin was less than 8 hours before balloon inflation, no additional dosing is required. If the last subcutaneous dose was given more than 8 hours before balloon inflation, an intravenous bolus of 0.3 mg/kg should be given.
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 to 325 mg once daily).
Obesity: Use actual body weight to calculate dose; dose capping not recommended.
Treatment should be given for a minimum of 2 days and continued until clinical stabilization. The vascular access sheath for instrumentation should remain in place for 6 to 8 hours following a dose of enoxaparin. The next scheduled dose should be given no sooner than 6 to 8 hours after sheath removal. The usual duration of treatment is 2 to 8 days; up to 12.5 days has been well tolerated in clinical trials.
Acute ST segment elevation myocardial infarction:
A single 30 mg intravenous bolus plus a 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 doses).
Obesity: Use weight based dosing; a maximum dose of 100 mg is recommended for the first 2 doses.
When given in conjunction with a thrombolytic, enoxaparin should be given between 15 minutes prior and 30 minutes after the start of fibrinolytic treatment. All patients should be given oral aspirin therapy (75 to 325 mg once daily unless contraindicated). An optimal duration of treatment is unknown, but it is likely to be longer than 8 days. In patients receiving thrombolytics, initiate enoxaparin dosing between 15 minutes before and 30 minutes after fibrinolytic therapy. For patients managed by PCI, if the last subcutaneous dose of enoxaparin was less than 8 hours before balloon inflation, no additional dosing is required. If the last subcutaneous dose was given more than 8 hours before balloon inflation, an intravenous bolus of 0.3 mg/kg should be given.
Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery:
30 mg subcutaneously every 12 hours. Provided that hemostasis has been established, the initial dose should be given 12 to 24 hours after surgery. For hip replacement surgery, a dose of 40 mg subcutaneously once a day given initially 12 hours prior to surgery may be considered. Following the initial phase of thromboprophylaxis in hip replacement surgery patients, continued prophylaxis with 40 mg subcutaneously once a day for 3 weeks is recommended. The usual duration of administration is 7 to 10 days; up to 14 days administration has been well tolerated in clinical trials.
In morbidly obese patients (BMI of 40 kg/m2 or greater), increasing the prophylactic dose by 30% may be appropriate.
Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery:
30 mg subcutaneously every 12 hours. Provided that hemostasis has been established, the initial dose should be given 12 to 24 hours after surgery. For hip replacement surgery, a dose of 40 mg subcutaneously once a day given initially 12 hours prior to surgery may be considered. Following the initial phase of thromboprophylaxis in hip replacement surgery patients, continued prophylaxis with 40 mg subcutaneously once a day for 3 weeks is recommended. The usual duration of administration is 7 to 10 days; up to 14 days administration has been well tolerated in clinical trials.
In morbidly obese patients (BMI of 40 kg/m2 or greater), increasing the prophylactic dose by 30% may be appropriate.
Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Abdominal Surgery:
40 mg subcutaneously once a day with the initial dose given 2 hours prior to surgery. The usual duration of administration is 7 to 10 days; up to 12 days administration has been well tolerated in clinical trials.
Bariatric surgery:Roux en Y gastric bypass: Appropriate dosing strategies have not been clearly defined.
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
Note: Bariatric surgery guidelines suggest initiation 30 to 120 minutes before surgery and postoperatively until patient is fully mobile. Alternatively, limiting administration to the postoperative period may reduce perioperative bleeding.
Usual Geriatric Dose for Myocardial Infarction:
Acute ST segment elevation myocardial infarction:
Patients greater than 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 first two doses only, followed by 0.75 mg/kg for the remaining doses).
No dose adjustments are required for other indications unless kidney function is impaired.
Usual 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.
Usual 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.
Alternate dosing:
Note: Several recent studies suggest that higher doses (especially in preterm neonates, neonates, and young infants) than those recommended. Some centers are using the following; however, further studies are needed to validate these proposed higher initial doses.
Premature neonates: 2 mg/kg/dose every 12 hours
Full term neonates: 1.7 mg/kg/dose every 12 hours
Infants less 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
What other drugs will affect enoxaparin?
Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding, and it is very important to tell your doctor about all medicines you have recently used. Bleeding or blood clots around the brain or spinal cord may occur if you use enoxaparin with other drugs that can affect blood clotting, such as:
dextran (Gentran, Hyskon);
heparin, warfarin (Coumadin);
abciximab (ReoPro), eptifibatide (Integrelin), tirofiban (Aggrastat);
cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine, Aggrenox), prasugrel (Effient), ticlopidine (Ticlid);
dalteparin (Fragmin), fondaparinux (Arixtra), tinzaparin (Innohep);
argatroban (Acova), bivalirudin (Angiomax), lepirudin (Refludan);
alteplase (Activase), tenecteplase (TNKase), urokinase (Abbokinase);
an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others; or
salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan's Pills Extra Strength, Pepto-Bismol, Tricosal, and others.
This list is not complete and other drugs may interact with enoxaparin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More enoxaparin resources
- Enoxaparin Side Effects (in more detail)
- Enoxaparin Dosage
- Enoxaparin Use in Pregnancy & Breastfeeding
- Enoxaparin Drug Interactions
- Enoxaparin Support Group
- 8 Reviews for Enoxaparin - Add your own review/rating
- enoxaparin Subcutaneous, Injection Advanced Consumer (Micromedex) - Includes Dosage Information
- Enoxaparin MedFacts Consumer Leaflet (Wolters Kluwer)
- Enoxaparin Sodium Monograph (AHFS DI)
- Lovenox Prescribing Information (FDA)
- Lovenox Consumer Overview
Compare enoxaparin with other medications
- Acute Coronary Syndrome
- Angina
- Deep Vein Thrombosis
- Deep Vein Thrombosis Prophylaxis after Abdominal Surgery
- Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery
- Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery
- Deep Vein Thrombosis, Prophylaxis
- Heart Attack
Where can I get more information?
- Your doctor or pharmacist can provide more information about enoxaparin.
See also: enoxaparin side effects (in more detail)
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