Adult Dosing
DVT prophylaxis in abdominal surgery
- 40 mg SC qd with the initial dose given 2 hrs prior to surgery
- Usual duration is 7-10 days up to 12 days
DVT prophylaxis in knee replacement surgery
- Recommended dose: 30 mg SC q12 hrs initial dose should be given 12-24 hrs after surgery
- Usual duration is 7-10 days up to 14 days
DVT prophylaxis in hip replacement surgery
- 30 mg SC q12 x 7-10 days, up to 14 days
- Start 12-24 hrs after surgery
- Alt: 40 mg SC qd x 7-10 days
- Start dose 12 hrs before surgery
- Extended prophylaxis with 40 mg SC qd x 3 wks may be continued after the initial phase of thromboprophylaxis
DVT prophylaxis in medical patients during acute illness
- 40 mg SC qd x 6-11 days, up to 14 days
Outpatient treatment of acute DVT without pulmonary embolism
- 1 mg/kg SC q12 hrs (with warfarin) x 7 days, up to 17 days
Inpatient treatment of acute DVT with or without pulmonary embolism
- 1 mg/kg SC q12 hrs: Alt: 1.5 mg/kg SC qd (with warfarin) x 7 days, up to 17 days
Note:
- Warfarin should be initiated within 72 hrs; enoxaparin to be continued for >5 days and until therapeutic anti-coagulant effect has been achieved (INR: 2.0-3.0)
Unstable angina and non-Q-wave MI
- 1 mg/kg SC q12 hrs with aspirin 100-325 mg PO qd for at least 2 days
- Usual duration of treatment is 2-8 days, up to 12.5 days
Acute ST-segment elevation MI
<75 yrs
- 1 mg/kg SC plus single IV bolus of 30 mg followed by 1 mg/kg SC q12 hrs x >8 days (with aspirin 75-325 mg qd); Max: 100 mg for the first two SC doses only, followed by 1 mg/kg for the remaining doses
>75 yrs
- 0.75 mg/kg SC q12 hrs x 8 days (with aspirin); do not use an initial IV bolus
- Max: 75 mg for the first two SC doses only, followed by 0.75 mg/kg for the remaining doses
Notes:- When administered with a thrombolytic, therapy should be given between 15 minutes before and 30 minutes after the start of fibrinolytic therapy; enoxaparin is continued for 8 days or until hospital discharge
- For patients managed with PCI, no additional dosing is required if the last SC injection was given <8 hrs before balloon inflation. However, if the last SC administration was given >8 hrs before balloon inflation, administer an IV bolus of 0.3 mg/kg enoxaparin
Acute Coronary Syndromes [Non-FDA Approved]
- 1mg/kg SC q12 hrs for total 48hrs
Prophylaxis of thromboembolism in nonvalvular atrial fibrillation
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
DVT [Non-FDA Approved]
Infant <2 month
Infant 
2 month
Pulmonary embolism [Non-FDA Approved]
Infant <2 month
Infant or child 2 month
- 1 mg/kg/dose SC q12 hrs, alt: 1.5 mg/kg/dose/day SC
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Mild to moderate renal impairment: No dose adjustments
- CrCl <30 mL/min:
- Prophylaxis in abdominal surgery
- Prophylaxis in hip or knee replacement surgery
- Prophylaxis in medical patients during acute illness
- Inpatient treatment of acute DVT with or without pulmonary embolism, when co-administered with warfarin
- Outpatient treatment of acute DVT without pulmonary embolism, when co-administered with warfarin
- Prophylaxis of ischemic complications of unstable angina and non-Q-wave MI, when co-administered with aspirin
- Treatment of acute ST-segment elevation MI, when co-administered with aspirin in patients <75 years
- 30 mg IV bolus plus 1 mg/kg SC followed by 1 mg/kg SC qd
- Treatment of acute ST-segment elevation MI, when co-administered with aspirin in patients 75 years
- 1 mg/kg SC qd (no initial bolus)
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined; caution advised
See Supplemental Patient Information
- Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture [US Black Box Warning]
- Hematomas may result in long-term or permanent paralysis. Consider these risks when planning for spinal procedures
- Factors that increase the risk of developing epidural or spinal hematomas include: Use of indwelling epidural catheters, concomitant use of drugs affecting hemostasis, history of traumatic or repeated epidural or spinal punctures, history of spinal deformity or spinal surgery [US Black Box Warning]
- Major hemorrhages including retroperitoneal and intracranial bleeding, which could be fatal, have been reported; bleeding can occur at any site during therapy
- To minimize the risk of bleeding after the vascular instrumentation during the treatment of unstable angina, non-Q-wave MI, and acute STEMI; adhere precisely to the recommended dosing intervals and the sheath removal recommendations
- Enoxaparin 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
- Thrombocytopenia may occur with use of enoxaparin therapy; monitor the platelet counts regularly during therapy; if the platelet count falls below 100,000/mm3, discontinue the treatment
- Cases of heparin-induced thrombocytopenia with thrombosis have been reported during therapy; some of these were complicated by organ infarction, limb ischemia, or death
- Enoxaparin cannot be used interchangeably (unit for unit) with heparin or other low molecular weight heparins
- In some pregnant women with mechanical prosthetic heart valves, enoxaparin (1 mg/kg twice daily) given to reduce the risk of thromboembolism produced clots resulting in blockage of the valve leading to maternal and fetal death
- Complete blood counts including platelet count and stool occult blood tests are recommended regularly during the course of treatment with enoxaparin
- Enoxaparin multiple-dose vials, preserved with benzyl alcohol, should be used with caution in pregnant women and only if clearly indicated
- In patients with significant renal impairment, anti-factor Xa may be used to monitor the anticoagulant effect of enoxaparin
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Wt <45 kg (female pts) or <57 kg (male pts)
- Coagulation disorder
- Bleeding risk
- Recent trauma or after brain, spinal or ophthalmological surgery
- History of GI ulcer or bleed
- Active GI ulcer or disease
- Hemorrhagic stroke
- Acute endocarditis
- Congenital or acquired bleeding disorders
- Elderly patients
- Concomitant platelet inhibitors
Supplemental Patient Information
- Inform patients receiving enoxaparin therapy that it may take them longer than usual to stop bleeding
- Advise patients that they may bruise and/or bleed more easily during therapy
- Instruct patients to report their physicians any unusual bleeding, bruising, or signs of thrombocytopenia that may occur during therapy
Pregnancy Category:B
Breastfeeding: Safety unknown: Limited information indicates that maternal enoxaparin doses up to 40 mg daily do not cause any adverse effects in breastfed infants. Because of its large molecular weight of 2000 to 8000 daltons, enoxaparin would not be expected to be excreted into breastmilk or to be absorbed from breastmilk by the infant. No special precautions are required. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 08 March 2011). Manufacturer recommends caution for use in nursing mothers.
Pricing data from www.DrugStore.com in U.S.A.
- Lovenox 30 MG/0.3ML SOLN [Syringe] (SANOFI-AVENTIS U.S.)
3 0.3ml = $259.99
9 0.3ml = $735.97 - Lovenox 40 MG/0.4ML SOLN [Syringe] (SANOFI-AVENTIS U.S.)
4 0.4ml = $354.23
12 0.4ml = $1038.32 - Enoxaparin Sodium 40 MG/0.4ML SOLN [Syringe] (SANDOZ)
0.4 0.4ml = $32.99
1.2 0.4ml = $80.97 - Lovenox 150 MG/ML SOLN [Syringe] (SANOFI-AVENTIS U.S.)
10 ml = $1250
20 ml = $2399.99 - Lovenox 100 MG/ML SOLN [Syringe] (SANOFI-AVENTIS U.S.)
10 ml = $815.98
20 ml = $1575.96 - Lovenox 80 MG/0.8ML SOLN [Syringe] (SANOFI-AVENTIS U.S.)
8 0.8ml = $649.98
16 0.8ml = $1285.94
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
