Lovenox (Enoxaparin)
Lovenox
Enoxaparin Sodium
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Prescription Required.

Product of Canada.

Express Ships from Canada.

Prescription Required.
Product of Canada.
Express Ships from Canada.

Lovenox (enoxaparin)

What is Lovenox (enoxaparin)?

Lovenox, also known as enoxaparin, is a low molecular weight heparin used prophylactically and in the treatment of deep vein thrombosis (DVT) and certain ischemic complications of unstable angina and myocardial infarction.

How does Lovenox work?

Lovenox (enoxaparin) is a low molecular weight heparin that acts as an anticoagulant by inhibiting clotting factor Xa and binding to antithrombin III (AT-III). The enoxaparin-AT-III complex irreversibly inhibits factor IIa (thrombin). Enoxaparin preferentially inhibits factor Xa.

Dosage

Lovenox is a clear to pale-yellow solution available in the following dosage forms and strengths:

100 mg/ml Concentration

  • Single-Dose Prefilled Syringes: 30 mg/0.3 mL, 40 mg/0.4 mL
  • Single-Dose Graduated Prefilled Syringes: 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL
  • Multiple-Dose Vial: 300 mg/3 mL

150 mg/ml Concentration

  • Single-Dose Graduated Prefilled Syringes: 120 mg/0.8 mL, 150 mg/1 mL

The dosage varies by indication. For DVT, the general dosing is either 40 mg once daily or 30 mg every 12 hours. For most other uses, the dosage is 1 mg per kilogram of body weight every 12 hours.

How to Use

Lovenox is often given as a subcutaneous injection but can also be given intravenously under medical supervision. It should not be injected into a muscle.

Use a tuberculin syringe when using multiple-dose vials to ensure the withdrawal of the appropriate volume of the drug.

Lovenox prefilled syringes and graduated prefilled syringes are for single, one-time use only.

Subcutaneous injection

  • Patients should be lying or sitting down for the injection.
  • Do not expel the air bubble from prefilled syringes.
  • Do not inject into bruised areas or through clothing.
  • It should be injected in the right and left sides of the abdomen, at least 2 inches away from the belly button.
  • Advance the entire length of the needle into the skin fold held between the thumb and forefinger.

For detailed instructions on injection technique, please consult your pharmacist or doctor.

Storage

Store at 25°C (77°F). Temperature excursions are permitted between 15°C-30°C (59°F-86°F). Store in the original carton or packaging until ready to use. Do not store the multiple-dose vials for more than 28 days after the first use.

Overdosage

If there has been an overdose of Lovenox, seek medical attention due to the risk of hemorrhagic complications. Protamine sulfate is an antidote for Lovenox and other low molecular weight heparins that must be given through intravenous infusion under medical care. It is important to know the amount and when it was injected because that will help medical providers determine how much protamine sulfate will be needed.

Side Effects

Common side effects of  may include:

  • Nausea
  • Diarrhea
  • Anemia
  • Confusion
  • Pain or bruising around the injection site

Serious side effects are possible with Lovenox. Contact your doctor if you experience any of the following signs or symptoms of a serious side effect.

  • Nerve problems
    • Symptoms: back pain, numbness, tingling, or muscle weakness
  • Bleeding problems
    • Symptoms: throwing up or coughing up blood, blood in the urine, black or red tarry stools, bleeding from the gums, abnormal vaginal bleeding, abnormal bruising
  • Bleeding in the brain
    • Symptoms: sudden weakness on one side of the body, sudden severe headache, problems with speech or vision
  • Severe allergic reaction
    • Symptoms: hives, burning or itching skin, difficulty breathing, swelling of face, lips, or tongue

This is not a comprehensive list of all possible side effects. Contact your pharmacist or doctor for more information.

Warnings & Precautions

Boxed warning

Spinal or Epidural Hematomas

  • Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins or heparinoids and receive neuraxial anesthesia or undergo spinal puncture. These hematomas may result in long-term or permanent paralysis.

Other Warnings and Precautions

Increased Risk of Hemorrhage

  • Use Lovenox with extreme caution in conditions with increased risk of hemorrhage, such as bacterial endocarditis, congenital or acquired bleeding disorders, active ulcerative and angiodysplastic gastrointestinal disease, hemorrhagic stroke, or shortly after brain, spinal, or ophthalmological surgery, or in patients treated concomitantly with platelet inhibitors.

Increased Risk of Bleeding following Percutaneous Coronary Revascularization Procedures

  • To minimize the risk of bleeding following the vascular instrumentation during the treatment of unstable angina, non–Q-wave myocardial infarction, or acute ST-segment elevation myocardial infarction, adhere precisely to the intervals recommended between Lovenox doses.

Increased Risk of Bleeding in Patients with Concomitant Medical Conditions

  • Lovenox should be used with care in patients with a bleeding diathesis, uncontrolled arterial hypertension, or a history of recent gastrointestinal ulceration, diabetic retinopathy, renal dysfunction, and hemorrhage.

Risk of Heparin-Induced Thrombocytopenia with or without Thrombosis

  • Lovenox may cause heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia with thrombosis (HITTS).

Interchangeability with other Heparins

  • Lovenox cannot be used interchangeably (unit for unit) with heparin or other low molecular weight heparins as they differ in the manufacturing process, molecular weight distribution, anti-Xa and anti-IIa activities, units, and dosage.

Increased Risk of Thrombosis in Pregnant Women with Mechanical Prosthetic Heart Valves

  • Using Lovenox for thromboprophylaxis in pregnant women with mechanical prosthetic heart valves may result in valve thrombosis.

Risk of Serious Adverse Reactions in Infants due to Benzyl Alcohol Preservative

  • Serious and fatal adverse reactions, including gasping syndrome, can occur in neonates and low-birth-weight infants treated with benzyl alcohol-preserved drugs, including Lovenox multiple-dose vials.

Drug Interactions and Other Interactions

If possible, medications that increase the risk of bleeding should be discontinued during treatment with Lovenox. Examples of medications that increase the risk of bleeding are anticoagulants, platelet inhibitors including acetylsalicylic acid, salicylates, NSAIDs (including ketorolac tromethamine), dipyridamole, or sulfinpyrazone.

Contraindications

Lovenox is contraindicated in patients with any of the following:

  • Active major bleeding
  • History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days
  • Known hypersensitivity to enoxaparin sodium (e.g., pruritus, urticaria, anaphylactic/anaphylactoid reactions)
  • Known hypersensitivity to heparin or pork products
  • Known hypersensitivity to benzyl alcohol (which is in only the multiple-dose formulation of Lovenox)

Frequently Asked Questions

Lovenox is used to prevent and treat certain types of blood clots in the legs or blood clots that can lead to heart attacks.

Lovenox is a low molecular weight heparin (LMWH) that works by inhibiting certain clotting factors (factor Xa and IIa) to prevent blood clots from forming.

You should use Lovenox as a subcutaneous injection. Never inject Lovenox into a muscle.

Use a tuberculin syringe when using Lovenox multiple-dose vials to ensure the withdrawal of the appropriate volume of drug.

Lovenox prefilled syringes and graduated prefilled syringes are for single, one-time use only.

Subcutaneous injection

  • You should be lying or sitting down for the injection.
  • Do not expel the air bubble from prefilled syringes.
  • Do not inject into bruised areas or through clothing.
  • Lovenox should be injected in the right and left sides of the abdomen, at least 2 inches away from the belly button.
  • Advance the entire length of the needle into the skin fold held between the thumb and forefinger.

For detailed instructions on injection technique, please consult your pharmacist or doctor.

Do not push out the air bubble in pre-filled Lovenox syringes because that can lead to losing some of the medication.

Lovenox cannot be used in patients with any of the following:

  • Active major bleeding
  • History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days
  • History of reactions to enoxaparin sodium (e.g., redness, itching, other signs of allergic reaction)
  • History of reactions to heparin or pork products
  • History of reactions to benzyl alcohol (which is in only the multiple-dose formulation of Lovenox)

Lovenox (enoxaparin) is an anticoagulant known as a low molecular weight heparin. Lovenox and heparin work in similar ways, but Lovenox targets a more specific clotting factor. Lovenox is generally better tolerated by patients and requires fewer injections than heparin.

The common side effects of Lovenox may include the following:

  • Nausea
  • Diarrhea
  • Anemia
  • Confusion
  • Discomfort around the injection site

This is not a complete list of all possible side effects of Lovenox. Please contact your doctor or pharmacist for more information.

Contact your doctor if you experience any of the following signs or symptoms of a serious side effect.

  • Nerve problems
    • Symptoms: back pain, numbness, tingling, or muscle weakness
  • Bleeding problems
    • Symptoms: throwing up or coughing up blood, blood in the urine, black or red tarry stools, bleeding from the gums, abnormal vaginal bleeding, abnormal bruising
  • Bleeding in the brain
    • Symptoms: sudden weakness on one side of the body, sudden severe headache, problems with speech or vision
  • Severe allergic reaction
    • Symptoms: hives, burning or itching skin, difficulty breathing, swelling of face, lips, or tongue

This is not a complete list of all possible side effects of Lovenox. Please contact your doctor or pharmacist for more information.

The active ingredient in all forms of Lovenox is enoxaparin sodium. The inactive ingredient in the pre-filled syringes is water only, and water and benzyl alcohol in the multiple-dose vials.

Store Lovenox at 25°C (77°F). Temperature excursions are permitted between 15°C-30°C (59°F-86°F). Store in the original carton or packaging until you are ready to use the medication. Discard multiple-dose vials 28 days after the first use.

Take the missed dose as soon as you remember. If it is close to your next dose, skip the missed dose and resume your regular dosing schedule. Never take 2 doses at the same time.

Lovenox can increase your risk for bleeding, especially when used in combination with other medications that also increase bleeding risk. Make sure your doctor knows about all the medications that you are taking, including prescription, over the counter, and natural supplements. Talk to your doctor or pharmacist before taking any new medications.

Lovenox does not interact with any foods, so there is no need to change your diet when starting the medication.

If possible, avoid activities that increase your risk of bleeding, bruising, or injury. Use extra caution while shaving and brushing your teeth.

Seek medical attention due to the risk of bleeding complications. There is an antidote for Lovenox that must be given under medical care. If possible, keep track of the amount of Lovenox that was injected and at what time it was injected because that will help medical providers determine how much of the antidote will be needed.