Parenteral Manual

Enoxaparin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
LOVENOX®
Classification: 
Antithrombotic-low molecular weight heparin
Original Date: 
August 2005
Revised Date: 
April 2017
Indications: 
  • Prophylaxis and treatment of thromboembolic disorders (deep vein thrombosis)
Reconstitution and Stability: 
  • Available as multiple dose vials of 100 mg/mL
  • Store at room temperature
  • Multi-dose vials stable 30 days refrigerated once punctured
  • Syringes stable 10 days refrigerated (drawn up from multi-dose vials)

 

Compatibility: 

- Solutions Compatible: 0.9% NaCl

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: no information

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC

YES- inject in the anterolateral or posterolateral abdominal girdle, alternate right and left sides.  DO NOT rub injection site after administration as bruising may occur
Usual dilution:  100 mg/mL
- 20 mg/mL for dose less than or equal to 10 mg

IM NO
IV Direct

YES, used investigationally

IV Intermittent Infusion NO
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric(<18 years):
- Treatment Dose:

  • <2 months: 1.75 mg/kg/dose Q 12 hours
  • 2 mth-18 years: 1 mg/kg/dose Q 12 hours

- Prophylactic Dose:

  • < 2 months: 0.75 mg/kg/dose Q 12 hours
  • 2 mth - 18 years: 0.5 mg/kg/dose Q 12 hours

- Maximum Dose:                         

  • 2 mg/kg/dose Q12 H (4 mg/kg/day)
Potential hazards of parenteral administration: 
  • Bruising, hematemesis, nosebleed, melena, coffee ground emesis, hematuria, hemoptysis, thrombocytopenia
  • Leg pain, fever, hypotension, dizziness, vomiting, confusion, edema, dyspnea
  • Transient asymptomatic elevations of liver transaminases (AST, ALT); reversible in 3-7 days after discontinuing the drug
Notes: 
  • Before initiation of treatment -  review patient's total drug regimen to prevent concomitant use of low molecular weight heparin and unfractionated heparin.
  • Hold for 2 doses prior to invasive procedures, eg. spinal puncture.
  • Avoid using in patients sensitive to pork products.
  • Use with caution in patients with uncontrolled arterial hypertension, recent GI ulceration
  • Obtain CBC, PT, and APTT prior to initiation of enoxaparin therapy                                
  • Monitor platelet counts daily, antifactor Xa (if initial measurement is therapeutic, monitor once weekly)
  • Elimination may be delayed in renal impairment - monitor antifactor Xa levels and watch for bleeding
  • Drug Interactions: anticoagulants, platelet inhibitors (aspirin, NSAIDS) may increase risk of bleeding

- Therapeutic antifactor Xa level (measured 4 - 6 hours after SC administration)

  • Treatment dose: 0.5 - 1 unit/mL
  • Prophylactic dose: 0.2 - 0.4 units/mL

Antidote:

  • Discontinue enoxaparin
  • 1 mg of protamine per 1 mg of enoxaparin given in last dose (administer protamine IV over 10 minutes)

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