Names and pronunciation
(ee-nox′a-par-in) Lovenox
Source page 470
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Individual generic drug information
Extracted information for enoxaparin only.
(ee-nox′a-par-in) Lovenox
Source page 470
Func. class.: Anticoagulant, an- tithrombotic
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Chem. class.: Low-molecular-weight heparin (LMWH)
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Do not confuse: enoxaparin/enoxacin Lovenox/Lotronex
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ACTION: Binds to antithrombin III inactivating factors Xa/IIa, thereby result- ing in a higher ratio of anti–factor Xa to IIa
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USES: Prevention of DVT (inpatient or outpatient), PE (inpatient) in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina, acute MI, coronary artery thrombosis
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Unlabeled uses: Antiphospholipid anti- body syndrome, arterial thromboembolism prophylaxis, cerebral thromboembolism, percutaneous coronary intervention
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Extracted information for enoxaparin only.
CONTRAINDICATIONS: Hyper- sensitivity to this product, heparin, pork; active major bleeding, hemophilia, leu- kemia with bleeding, thrombocytopenic purpura, heparin-induced thrombocyto- penia Precautions: Pregnancy, breastfeeding, children, geriatric patients, low-weight men (<57 kg), women (<45 kg), severe renal/ hepatic disease, severe hypertension, sub- acute bacterial endocarditis, acute nephri- tis, recent burn, spinal surgery, indwelling catheters, hypersensitivity to benzyl alcohol
Source pages 470, 471
Black Box Warning: Lumbar puncture, aneurysm, coagulopathy, epidural anes- thesia, spinal anesthesia Black Box Warning: Neurologic symp- toms in patients who have received spinal anesthesia, may develop spinal hematoma; those who have had trauma, spinal surgery are at greater risk • Beers: reduce dose in older adults; in- creased bleeding risk, or if CCr <30 mL/min • Pregnancy/breastfeeding: do not use in multidose vials, benzyl alcohol is pres ent; do not breastfeed
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SIDE EFFECTS CNS: Fever, confusion, dizziness, headache GI: Nausea, vomiting, constipation HEMA: Hemorrhage from any site, hypo- chromic anemia, thrombocytopenia, bleeding INTEG: Ecchymosis, injection site hema- toma, alopecia, pruritus, rash META: Hyperkalemia in renal failure MS: Osteoporosis SYST: Edema, peripheral edema, angio- edema, anaphylaxis
Source page 472
INTERACTIONS Increase: enoxaparin action—anticoag- ulants, salicylates, NSAIDs, antiplatelets, thrombolytics, RU-486, SSRIs; monitor INR/PT Drug/Lab Test Increase: AST, ALT Decrease: platelet count Drug/Herb Increase: bleeding risk—feverfew, garlic, ginger, ginkgo, green tea, horse chestnut
Source page 472
Extracted information for enoxaparin only.
DOSAGE AND ROUTES DVT prevention prior to hip or knee surgery • Adult: SUBCUT 30 mg bid given 12- 24 hr postop for 7-10 days DVT prevention prior to hip replacement • Adult: SUBCUT 40 mg/day started 9-12 hr preop or 30 mg q12hr started 12-24 hr postop DVT prophylaxis prior to abdominal surgery • Adult: SUBCUT 40 mg/day starting 24 hr prior to surgery × 7-12 days Treatment of DVT or PE • Adult: SUBCUT 1 mg/kg q12hr (without PE, outpatient); 1 mg/kg q12hr or 1.5 mg/ kg/day (with or without PE, inpatient); war- farin should be started within 72 hr, contin- ued ≥5 days until INR is 2-3 (at least 3 days) DVT prophylaxis in patients with re- stricted mobility due to acute illness • Adult: SUBCUT 40 mg q24hr Prevention of ischemic complications in unstable angina or non–Q-wave MI/non-ST • Adult: SUBCUT/IV 1 mg/kg q12hr until stable with aspirin 100-325 mg/day Acute MI with ST-segment elevation • Adult/geriatric <75 yr: IV/SUBCUT 30 mg IV BOLUS plus 1 mg/kg SUBCUT, then 1 mg/kg SUBCUT q12hr, max 100 mg for first 2 doses only • Geriatric ≥75 yr: SUBCUT 0.75 mg/kg q12hr, max 75 mg for first 2 doses only Renal dose • Adult: SUBCUT CCr <30 mL/min: 30 mg daily (thrombosis prophylaxis in ab- dominal surgery, hip or knee replace- ment surgery, during acute illness); 1 mg/kg daily (concurrently with aspirin to treat unstable angina or non-Q-wave MI); 1 mg/kg daily (STEMI in those ≥75 yr), 30 mg IV bolus plus 1 mg/kg SC, then 1 mg/kg daily (STEMI in those <75 yr), or 1 mg/kg daily (concurrently with warfa- rin for inpatient or outpatient treatment of acute deep vein thrombosis with or E without pulmonary embolism)
Source page 471
Available forms: Prefilled syringes 30 mg/0.3 mL, 40 mg/0.4 mL; graduated pre- filled syringes 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL, 120 mg/0.8 mL, 150 mg/mL
Source page 471
Administer: • Only after screening patient for bleed- ing disorders • Do not mix with other products or infu- sion fluids • Only this product when ordered; not in- terchangeable with heparin or other LMWHs • At same time each day to maintain steady blood levels • Avoid all IM injections that may cause bleeding • Prepare in a sterile environment using aseptic technique SUBCUT route • Do not give IM; begin 1 hr prior to surgery; do not aspirate; rotate sites; do not expel bubble from syringe before administration • To recumbent patient, give SUBCUT; ro- tate injection sites (left/right anterolateral, left/right posterolateral abdominal wall) • Insert whole length of needle into skin fold held with thumb and forefinger • If withdrawing from multidose vial, use TB syringe for proper measure- ment • Prefilled syringes (30, 40 mg) not graduated; do not use for partial doses • Do not administer if particulate is present; do not use products with benzyl alcohol in pregnant women Direct IV route • Use multidose vial for IV administra- tion; use TB syringe, other graduated syringe to measure dose; give IV BO- LUS through IV line, flush prior to and after • Dilution may be stored for up to 4 wk in glass vial at room temperature, up to 2 wk in TB syringes with rubber stoppers at room temperature or refrigerated
Source pages 471, 472
Extracted information for enoxaparin only.
Assess: • Monitor anti—factor Xa activity in chronic therapy (renal disease) • Blood studies (Hct/Hb, CBC, coagula- tion studies, platelets [for HIT], occult blood in stools), anti–factor Xa (should be checked 4 hr after injection); throm- bocytopenia may occur; PT, PTT is not needed in those with adequate coagula- tion; discontinue use and notify pre- scriber if platelets <100,000/mm3 • Renal studies: BUN/creatinine base- line and periodically • Bleeding: gums, petechiae, ecchymo- sis, black tarry stools, hematuria; notify prescriber • Anaphylaxis, angioedema: monitor for rash; swelling of face, lips, tongue; dyspnea; stop product, initiate emergency procedures • Neurologic status: those with epidural catheters are at greater chance for im- pairments • Injection site reactions: inflammation, redness, hematomas
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Evaluate: • Therapeutic response: prevention of DVT/PE
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Black Box Warning: Spinal anes- thesia: to report numbness, weakness in lower extremities • To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor • To report any signs of bleeding: gums, under skin, urine, stools; do not rub injec- tion site, easy bruising • To report dizziness, rash, breathing changes • To teach how to use SUBCUT form • To have patient discuss all products taken with all prescribers and health care providers • To avoid OTC products containing aspirin, NSAIDs unless approved by prescriber; not to start any Rx, OTC, supplements, or herbal products unless approved by prescriber
Source page 472
Extracted information for enoxaparin only.
PHARMACOKINETICS SUBCUT: 90% absorbed, maximum anti- thrombin activity (3-5 hr), duration 12 hr half-life 4½ hr, excreted in urine
Source page 472
Filter the extracted dose blocks for this individual drug.
DVT prevention prior to hip or knee surgery
• Adult: SUBCUT 30 mg bid given 12- 24 hr postop for 7-10 days DVT prevention prior to hip replacement
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Adult: SUBCUT 40 mg/day started 9-12 hr preop or 30 mg q12hr started 12-24 hr postop DVT prophylaxis prior to abdominal surgery
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Adult: SUBCUT 40 mg/day starting 24 hr prior to surgery × 7-12 days Treatment of DVT or PE
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Adult: SUBCUT 1 mg/kg q12hr (without PE, outpatient); 1 mg/kg q12hr or 1.5 mg/ kg/day (with or without PE, inpatient); war- farin should be started within 72 hr, contin- ued ≥5 days until INR is 2-3 (at least 3 days) DVT prophylaxis in patients with re- stricted mobility due to acute illness
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Adult: SUBCUT 40 mg q24hr Prevention of ischemic complications in unstable angina or non–Q-wave MI/non-ST
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Adult: SUBCUT/IV 1 mg/kg q12hr until stable with aspirin 100-325 mg/day Acute MI with ST-segment elevation
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Adult/geriatric <75 yr: IV/SUBCUT 30 mg IV BOLUS plus 1 mg/kg SUBCUT, then 1 mg/kg SUBCUT q12hr, max 100 mg for first 2 doses only
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Geriatric ≥75 yr: SUBCUT 0.75 mg/kg q12hr, max 75 mg for first 2 doses only Renal dose
Candidate age grouping · source page 471
DVT prevention prior to hip or knee surgery
• Adult: SUBCUT CCr <30 mL/min: 30 mg daily (thrombosis prophylaxis in ab- dominal surgery, hip or knee replace- ment surgery, during acute illness); 1 mg/kg daily (concurrently with aspirin to treat unstable angina or non-Q-wave MI); 1 mg/kg daily (STEMI in those ≥75 yr), 30 mg IV bolus plus 1 mg/kg SC, then 1 mg/kg daily (STEMI in those <75 yr), or 1 mg/kg daily (concurrently with warfa- rin for inpatient or outpatient treatment of acute deep vein thrombosis with or E without pulmonary embolism)
Candidate age grouping · source page 471