Monograph Details
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Hematology
> Thromboembolic disorders
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LOVENOX |
| Manufacturer |
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Sanofi Aventis |
| Legal Classification |
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Rx
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| Pharmacological Class |
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Low molecular weight heparin. |
| Generic Name |
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Enoxaparin sodium 100mg/mL, 150mg/mL; syringes (preservative-free); 300mg/3mL multidose vials (contain benzyl alcohol). |
| Indications |
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Prevention of DVT in hip or knee replacement surgery, or in abdominal surgery or acutely ill patients with severely restricted mobility at risk for thromboembolism. With warfarin: for inpatient treatment of acute DVT with or without pulmonary embolism (PE), or outpatient treatment of acute DVT without PE. With aspirin: to prevent ischemic complications of unstable angina and non-Q-wave MI. Treatment of acute ST-segment elevation MI (STEMI) managed medically or with subsequent percutaneous coronary intervention (PCI). |
| Children |
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Not recommended. |
| Adults |
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For post-op dosing, assure hemostasis before starting. Knee: 30mg SC every 12 hrs for 7–10 days; max 14 days (1st dose 12–24 hrs post-op). Hip: 30mg SC every 12 hours (1st dose 12–24 hrs post-op), or 40mg SC once daily (1st dose 9–15 hrs pre-op), for 7–10 days, then 40mg SC once daily for 3 weeks. Abdominal: 40mg SC once daily (1st dose 2 hrs pre-op) for 7–10 days; max 12 days. Severely restricted mobility due to acute illness: 40mg SC once daily for 6–11 days, max 14 days. DVT (without PE) outpatient: 1mg/kg every 12 hrs SC; inpatient (with or without PE): 1mg/kg every 12 hrs SC or 1.5mg/kg once daily SC; for both, start warfarin usually within 72 hrs, continue enoxaparin at least 5 days and until INR is between 2–3 (usually 7 days; usual max 17 days). Unstable angina and non-Q-wave MI: 1mg/kg SC every 12 hrs for at least 2 days, with aspirin 100–325mg once daily, until stable (usually 2–8 days; usual max 12.5 days). STEMI: 30mg IV bolus plus 1mg/kg SC dose, then 1mg/kg SC every 12 hrs (max 100mg for 1st 2 doses only, then 1mg/kg dosing for remaining doses), with aspirin 75–325mg once daily; usually for 8 days or until hospital discharge. Concomitant thrombolytics: give between 15 minutes before or 30 minutes after start of fibrinolytic therapy. PCI: if last enoxaparin dose given <8 hrs before balloon inflation, no additional dose needed; >8 hrs before balloon inflation, give 0.3mg/kg IV bolus. Elderly with STEMI: ≥75yrs: Do not give IV bolus; initially 0.75mg/kg SC every 12 hrs (max 75mg for 1st 2 doses only, then 0.75mg/kg dose for remaining doses). Severe renal impairment (CrCl<30mL/min) or low body weight: adjust dose (see literature). |
| Contraindications |
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Active major bleeding. Thrombocytopenia associated with a (+) in vitro test for antiplatelet antibody associated with enoxaparin sodium. Hypersensitivity to heparin or pork products. |
| Precautions |
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Prosthetic heart valves: not recommended (esp. if pregnant). Neuraxial anesthesia and post-op indwelling epidural catheter or spinal puncture (risk of epidural or spinal hematoma). Heparin-induced thrombocytopenia. Bacterial endocarditis. Bleeding disorders. Bleeding diathesis. Active ulceration and angiodysplastic GI disease. Recent history of GI ulcer. Hemorrhagic stroke. Uncontrolled hypertension. Diabetic retinopathy. Recent brain, spinal or eye surgery. Renal impairment or low body weight (monitor bleeding). PCI: obtain hemostasis before sheath removal; monitor site for bleeding or hematoma (see literature). Monitor CBC and for occult blood in stool. Not interchangeable (unit-for-unit) with heparin or other low molecular weight heparins. Elderly. Pregnancy (Cat.B): monitor carefully (congenital anomalies, bleeding); avoid using multidose vials. Nursing mothers. |
| Interactions |
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Avoid concomitant drugs that affect hemostasis (eg, oral anticoagulants, platelet inhibitors including aspirin, NSAIDs, dipyridamole, sulfinpyrazone). |
| Adverse Reactions |
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Hemorrhage, thrombocytopenia, inj site reactions, fever, nausea, ecchymosis, hypochromic anemia, edema, skin necrosis, thrombocythemia, systemic allergic reaction, inflammatory nodules, elevated serum transaminases; angina/MI patients: also atrial fibrillation, heart failure, lung edema, pneumonia. |
| How Supplied |
Prefilled syringes 100mg/mL (30mg, 40mg)—10
Prefilled syringes 100mg/mL (60mg, 80mg, 100mg)—10
Prefilled syringes 150mg/mL (120mg, 150mg)—10
Multidose vial (300mg/3mL)—1 |
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