DrugindexOnline^{2nd edition}

Generic Name: enoxaparin (ee NOX ah peh rin)
Brand Names: Lovenox

What is enoxaparin?

Enoxaparin is an anticoagulant (blood thinner). Enoxaparin prevents the formation of blood clots.

Enoxaparin is used to prevent blood clot formation following knee or hip replacement surgery and following abdominal surgery in patients at high risk of developing a blood clot. Enoxaparin is also used with aspirin to prevent complications of certain types of angina and heart attacks, and with warfarin (Coumadin) to treat deep vein thrombosis (a type of blood clot).

Enoxaparin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about enoxaparin?

There is a risk of bleeding in the spinal or epidural space, possibly resulting in paralysis, when enoxaparin is used along with spinal or epidural anesthesia or spinal puncture. This risk may be increased by the use of indwelling epidural catheters or by the concomitant use of drugs that affect blood clotting.

Do not inject this medication intramuscularly (into the muscle) or intravenously (into the vein). Do not take aspirin, ibuprofen (Motrin, Advil, Nuprin, and others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, and others), indomethacin (Indocin), or any other nonsteroidal anti-inflammatory medication without first talking to your doctor. These medicines may lead to bleeding when taken with enoxaparin. Ask your pharmacist or doctor before taking any prescription or over-the-counter medication during treatment with enoxaparin.

What should I discuss with my healthcare provider before using enoxaparin?

Do not use enoxaparin without first talking to your doctor if you

• have a low level of platelets in your blood;

• have kidney disease;

• have uncontrolled active bleeding;

• have an allergy to pork products; or

• cannot have accurate blood testing done prior to and during dosing.

Before using enoxaparin, tell your doctor if you

• have bacterial endocarditis;

• have high blood pressure that is not being controlled;

• have eye problems due to diabetes (diabetic retinopathy);

• need to have surgery or another invasive procedure;

• have hemophilia or another blood disorder;

• have a stomach ulcer;

• have a prosthetic heart valve;

• have liver disease.

You may not be able to use enoxaparin, or you may require a dosage adjustment or special monitoring during therapy if you have any of the conditions listed above.

Patients with an allergy to benzyl alcohol should not use the multi-dose formulation of enoxaparin.

Enoxaparin is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not use enoxaparin without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether enoxaparin passes into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.

How should I use enoxaparin?

Use enoxaparin exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.

Enoxaparin must be used as a subcutaneous (under the skin) injection.

Do not inject this medication intramuscularly (into a muscle) or intravenously (into a vein).

Your doctor or nurse will give you detailed instructions on how to inject enoxaparin. It should be injected into the fat of the stomach. Follow your doctor's instructions.

When using a prefilled syringe, to prevent the loss of medication do not expel the air bubble before the injection.

Sit or lie down before receiving an injection. Lift a fold of skin and insert the needle completely into the fold. Continue to pinch the skin until the injection is complete. To lessen bruising, do not rub the area after injecting the medication. Rotate your injection sites as directed by your doctor.

Do not use any medication that is discolored or that has particles in it.

It is important to use enoxaparin regularly to get the most benefit.

Do not stop using this medication without first talking to your doctor.

Your doctor may want you to have blood tests or other medical evaluations during treatment with enoxaparin to monitor progress and side effects.

Store enoxaparin at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and use only the next regularly scheduled dose. Do not use a double dose of this medication.

Notify your doctor if you miss a dose of enoxaparin.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of an overdose include unusual bleeding from wounds or injection sites; nosebleeds; black, bloody, or tarry stools; blood in the urine; and easy bruising or bleeding.

What should I avoid while using enoxaparin?

Do not take aspirin, ibuprofen (Motrin, Advil, Nuprin, and others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, and others), indomethacin (Indocin), or any other nonsteroidal anti-inflammatory drug (NSAID) without first talking to your doctor. These medicines may lead to bleeding when taken with enoxaparin. Ask your pharmacist or doctor before taking any prescription or over-the-counter medication during treatment with enoxaparin.

Enoxaparin side effects

If you experience any of the following serious side effects, stop using enoxaparin, and seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

• prolonged or unexplained bleeding;

• pain, warmth, or redness in an arm or leg, or difficulty breathing, which could indicate a blood clot; or

• ulceration at the injection site.

Other less serious side effects may be more likely to occur. Continue to use enoxaparin and notify your doctor if you experience

• mild pain, redness, or warmth at the injection site;

• rash or itching;

• fever;

• nausea; or

• swelling or water retention.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect enoxaparin?

There is a risk of bleeding in the spinal or epidural space, possibly resulting in paralysis, when enoxaparin is used along with spinal or epidural anesthesia or spinal puncture. This risk may be increased by the use of indwelling epidural catheters or by the concomitant use of drugs that affect blood clotting.

Do not use enoxaparin with any of the following medicines without first talking to your doctor:

• aspirin,

• ibuprofen (Motrin, Advil, Nuprin, and others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, and others), indomethacin (Indocin), diclofenac (Cataflam, Voltaren), diflunisal (Dolobid), etodolac (Lodine), fenoprofen (Nalfon), flurbiprofen (Ansaid), ketorolac (Toradol), nabumetone (Relafen), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin), meloxicam (Mobic), or any other nonsteroidal anti-inflammatory medication;

• warfarin (Coumadin);

• ardeparin (Normiflo), dalteparin (Fragmin), danaparoid (Orgaran), or tinzaparin (Innohep);

• aspirin and dipyridamole (Aggrenox);

• ticlopidine (Ticlid) or clopidogrel (Plavix); or

• dipyridamole (Persantine).

The drugs listed above may increase the effects of enoxaparin, which could be dangerous. You may not be able to use enoxaparin, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with enoxaparin. Talk to your doctor and pharmacist before using any prescription or over-the-counter medicines, including herbal products.

Where can I get more information?

• Your pharmacist has additional information about enoxaparin written for health professionals that you may read.

What does my medication look like?

Enoxaparin is available with a prescription under the brand name Lovenox. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 6.01. Revision Date: 12/17/04 9:40:34 AM.