ENOXAPARIN

Low molecular weight heparin

Dosage forms

Sterile solution for injection

100 mg/ml

Sterile solution for injection in syringe

80 mg/0.8 ml

Uses

  • Treatment of deep vein thrombosis
  • Treatment of pulmonary embolism
  • Prophylaxis of deep vein thrombosis

Dose and duration

Administer by subcutaneous (SC) injection

Prophylaxis of deep vein thrombosis
Adult: 20 mg once daily for 7–10 days or until risk has diminished. Give 2 hours pre-operatively in patients undergoing surgery (40 mg once daily in orthopaedic surgery, first dose given 12 hours pre-operatively)
Prophylaxis of deep vein thrombosis in medical patients
Adult: 40 mg once daily for 6–14 days
Treatment of deep vein thrombosis, pulmonary embolism
Adult: 1.5 mg/kg once daily for at least 5 days and until adequate oral anticoagulation is established
Child 2 months–18 years: 1 mg/kg every 12 hours
Child 1–2 months: 1.5 mg/kg every 12 hours
Neonate: 1.5–2 mg/kg every 12 hours
Pregnancy: (see caution)
Body weight Dose every 12 hours
<50 kg 40 mg
50–70 kg 60 mg
70–90 kg 80 mg
>90 kg 100 mg

Contra-indications

  • Acute bacterial endocarditis
  • Active major bleeding
  • Haemorrhagic stroke
  • Haemophilia
  • Thrombocytopenia
  • Active gastric or duodenal ulceration
  • Hypersensitivity to enoxaparin, heparin or its derivatives

Side effects

  • Haemorrhage
  • Thrombocytosis, thrombocytopenia
  • Allergic reactions, urticaria, pruritus, erythema
  • Hepatic enzyme increases
  • Injection site reactions (e.g. haematoma, pain)

Interactions

  • Intravenous diclofenac (increased risk of haemorrhage)
  • Aspirin (anticoagulant effect enhanced)
  • Glyceryl trinitrate (reduced anticoagulant effect)

Pregnancy

  • Can be used (see caution)

Breast-feeding

  • Can be used

⚠️ Caution

  • Elimination is increased in pregnancy. Treatment should be stopped at the onset of labour and specialist advice sought on continuing therapy after birth
  • Reduce dose in renal impairment
  • Increased risk of bleeding in patients with low body weight and in renal impairment
  • Withdraw enoxaparin if haemorrhage occurs
  • Risk of suppression of adrenal secretion of aldosterone leading to hyperkalaemia in conditions such as diabetes mellitus, chronic renal failure, metabolic acidosis, hyperkalaemia or patients on potassium sparing medicines
  • Use with extreme caution in patients with a history of heparin-induced thrombocytopenia
  • Do not interchange with other low molecular weight heparins since they differ in their manufacturing process