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® REDESCA®
Classification: 
Antithrombotic-low molecular weight heparin
Original Date: 
August 2005
Revised Date: 
June 2026
Indications: 
  • Prophylaxis and treatment of thromboembolic disorders (deep vein thrombosis)
Reconstitution and Stability: 
  • Available as multiple dose vials of 100 mg/mL
  • Store vials in original cartons at room temperature
  • Multi-dose vials stable 30 days refrigerated once punctured
  • Do not use if solution has discoloration, opaque particles, or any foreign material observed

 

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, alternating right and left sides.  DO NOT rub injection site after administration as bruising may occur

Usual dilution:

  • Doses greater than 10 mg: 100 mg/mL (undiluted)
  • Doses less than or equal to 10 mg: 20 mg/mL
IM NO
IV Direct

NO
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 every 12 hours (MAX: 3 mg/kg/dose every 12 hours)
  • 2 months to 18 years: 1 mg/kg/dose every 12 hours (MAX: 2 mg/kg/dose every 12 hours)

Prophylactic Dose:

  • < 2 months: 0.75 mg/kg/dose every 12 hours OR 1.5 mg/kg/dose once daily
  • 2 months to 18 years: 0.5 mg/kg/dose every 12 hours OR 1 mg/kg/dose once daily (MAX: 30 mg every 12 hours OR 40 mg once daily)
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)
References: 
  • REDESCA product monograph
  • Lexicomp

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