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enoxaparin (e-nox-a-pa-rin)
Lovenox
Classification
Therapeutic: anticoagulants
Pharmacologic: antithrombotics, heparins (low molecular weight)
Pregnancy Category B
Indications
Prevention of venous thromboembolism (VTE) (deep vein thrombosis (DVT) and/or
pulmonary embolism (PE)) in surgical or medical patients. Treatment of DVT with or
without PE (with warfarin). Prevention of ischemic complications (with aspirin)
from unstable angina and non-ST-segment-elevation MI. Treatment of acute ST-segment-
elevation MI (with thrombolytics or percutaneous coronary intervention).
Action
Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. Therapeutic
Effects: Prevention of thrombus formation.
Pharmacokinetics
Absorption: 100% absorbed after subcut administration.
Distribution: Unknown.
Metabolism and Excretion: Metabolized in the liver, primarily renally eliminated
Clearancepby 30% in renal impairment (CCr 30 ml/min).
Half-life: Single dose: 4.5 hr; Repeat dosing: 7 hr.
TIME/ACTION PROFILE (anticoagulant effect)
ROUTE ONSET PEAK DURATION
Subcut unknown 3–5 hr 12 hr
Contraindications/Precautions
Contraindicated in: Hypersensitivity ; Hypersensitivity to benzyl alcohol (multidose
vial); Positive in vitro test for antiplatelet antibody in the presence of enoxaparin;
Active, major bleeding.
Use Cautiously in: Severe hepatic or renal disease (adjust dose if CCr 30 mL/
min); Retinopathy (hypertensive or diabetic); Uncontrolled hypertension; Recent
history of ulcer disease; History of congenital or acquired bleeding disorder; Women
45 kg and men 57 kg (qexposure to enoxaparin withqrisk of bleeding; weightadjusted
dosing recommended); Malignancy; Geri: May haveqrisk of bleeding due
to age-relatedpin renal function; OB, Lactation, Pedi: Safety not established;
should not be used in pregnant patients with prosthetic heart valves without careful
monitoring.
Exercise Extreme Caution in: Severe uncontrolled hypertension; Bacterial endocarditis;
Bleeding disorders; GI bleeding/ulceration/pathology; Hemorrhagic
stroke; Recent CNS or ophthalmologic surgery; History of thrombocytopenia related
to heparin; Spinal/epidural anesthesia or spinal puncture (qrisk of spinal/epidural
hematoma that may lead to long-termor permanent paralysis).
Adverse Reactions/Side Effects
CNS: dizziness, headache, insomnia. CV: edema. GI: constipation,qliver enzymes,
nausea, vomiting. GU: urinary retention. Derm: alopecia, ecchymoses, pruritus,
rash, urticaria. F and E: hyperkalemia. Hemat: bleeding, anemia, eosinophilia,
thrombocytopenia. Local: erythema at injection site, hematoma, irritation, pain.
MS: osteoporosis. Misc: fever.
Interactions
Drug-Drug: Risk of bleeding may beqby concurrent use of drugs that affect
platelet function and coagulation, including warfarin, aspirin, thrombolytic
agents, NSAIDs, dipyridamole, some penicillins, clopidogrel, abciximab, eptifibatide,
tirofiban, ticlopidine, and dextran.
Route/Dosage
VTE Prophylaxis
Subcut (Adults): Knee replacement surgery—30 mg q 12 hr starting 12–24 hr
after surgery for 7–10 days; Hip replacement—30 mg q 12 hr starting 12–24 hr
postop or 40 mg once daily starting 12 hr before surgery (either dose may be continued
for 7–14 days; continued prophylaxis with 40 mg once daily may be continued
for up to 3 wk); Abdominal surgery—40 mg once daily starting 2 hr before surgery
and then continued for 7–12 days or until ambulatory (up to 14 days); Medical patients
with acute illness—40 mg once daily for 6–14 days.
Subcut (Infants and Children 2mo—18 yr): 0.5 mg/kg/dose every 12 hr.
Subcut (Infants 1–2mo): 0.75 mg/kg/dose every 12 hr.
enoxaparin (e-nox-a-pa-rin)
Lovenox
Classification
Therapeutic: anticoagulants
Pharmacologic: antithrombotics, heparins (low molecular weight)
Pregnancy Category B
Indications
Prevention of venous thromboembolism (VTE) (deep vein thrombosis (DVT) and/or
pulmonary embolism (PE)) in surgical or medical patients. Treatment of DVT with or
without PE (with warfarin). Prevention of ischemic complications (with aspirin)
from unstable angina and non-ST-segment-elevation MI. Treatment of acute ST-segment-
elevation MI (with thrombolytics or percutaneous coronary intervention).
Action
Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. Therapeutic
Effects: Prevention of thrombus formation.
Pharmacokinetics
Absorption: 100% absorbed after subcut administration.
Distribution: Unknown.
Metabolism and Excretion: Metabolized in the liver, primarily renally eliminated
Clearancepby 30% in renal impairment (CCr 30 ml/min).
Half-life: Single dose: 4.5 hr; Repeat dosing: 7 hr.
TIME/ACTION PROFILE (anticoagulant effect)
ROUTE ONSET PEAK DURATION
Subcut unknown 3–5 hr 12 hr
Contraindications/Precautions
Contraindicated in: Hypersensitivity ; Hypersensitivity to benzyl alcohol (multidose
vial); Positive in vitro test for antiplatelet antibody in the presence of enoxaparin;
Active, major bleeding.
Use Cautiously in: Severe hepatic or renal disease (adjust dose if CCr 30 mL/
min); Retinopathy (hypertensive or diabetic); Uncontrolled hypertension; Recent
history of ulcer disease; History of congenital or acquired bleeding disorder; Women
45 kg and men 57 kg (qexposure to enoxaparin withqrisk of bleeding; weightadjusted
dosing recommended); Malignancy; Geri: May haveqrisk of bleeding due
to age-relatedpin renal function; OB, Lactation, Pedi: Safety not established;
should not be used in pregnant patients with prosthetic heart valves without careful
monitoring.
Exercise Extreme Caution in: Severe uncontrolled hypertension; Bacterial endocarditis;
Bleeding disorders; GI bleeding/ulceration/pathology; Hemorrhagic
stroke; Recent CNS or ophthalmologic surgery; History of thrombocytopenia related
to heparin; Spinal/epidural anesthesia or spinal puncture (qrisk of spinal/epidural
hematoma that may lead to long-termor permanent paralysis).
Adverse Reactions/Side Effects
CNS: dizziness, headache, insomnia. CV: edema. GI: constipation,qliver enzymes,
nausea, vomiting. GU: urinary retention. Derm: alopecia, ecchymoses, pruritus,
rash, urticaria. F and E: hyperkalemia. Hemat: bleeding, anemia, eosinophilia,
thrombocytopenia. Local: erythema at injection site, hematoma, irritation, pain.
MS: osteoporosis. Misc: fever.
Interactions
Drug-Drug: Risk of bleeding may beqby concurrent use of drugs that affect
platelet function and coagulation, including warfarin, aspirin, thrombolytic
agents, NSAIDs, dipyridamole, some penicillins, clopidogrel, abciximab, eptifibatide,
tirofiban, ticlopidine, and dextran.
Route/Dosage
VTE Prophylaxis
Subcut (Adults): Knee replacement surgery—30 mg q 12 hr starting 12–24 hr
after surgery for 7–10 days; Hip replacement—30 mg q 12 hr starting 12–24 hr
postop or 40 mg once daily starting 12 hr before surgery (either dose may be continued
for 7–14 days; continued prophylaxis with 40 mg once daily may be continued
for up to 3 wk); Abdominal surgery—40 mg once daily starting 2 hr before surgery
and then continued for 7–12 days or until ambulatory (up to 14 days); Medical patients
with acute illness—40 mg once daily for 6–14 days.
Subcut (Infants and Children 2mo—18 yr): 0.5 mg/kg/dose every 12 hr.
Subcut (Infants 1–2mo): 0.75 mg/kg/dose every 12 hr.
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