Lovenox (Enoxaparin)

(℞) Prescription Required

    Lovenox Injection (Enoxaparin) Dosage and Side Effects

    LOVENOX is an anti-thrombotic drug. This means that LOVENOX helps to prevent blood clots from forming in patients who have either undergone surgery or are suffering from a medical condition that limits their mobility. It can also treat existing blood clots in deep veins or in unstable coronary artery disease (Unstable Angina or non Q-wave Myocardial Infarction).

    Proper Use of this medication

    Usual dose:

    LOVENOX is a prescription drug and must be used as directed. Usually it is administered as a subcutaneous injection, which means the injection is made just under the surface of the skin. For some conditions, LOVENOX may be administered as an intravenous (IV) injection. LOVENOX must NOT be administered by the intramuscular route.

    Hip or Knee Replacement Surgery: While you are in the hospital, your doctor or a nurse will give your first injection within 24 hours after your operation, so as to prevent blood clots from forming. After that, your doctor or a nurse will give you 2 subcutaneous injections every day (one injection every 12 hours) while you are in hospital.

    In case of hip replacement surgery, after completing the treatment with 2 subcutaneous injections per day, your doctor may ask you to take 1 subcutaneous injection every day for the following days at home or in hospital for an additional 3 weeks.

    Abdominal or Colorectal Surgery: While you are in the hospital, your doctor or a nurse will give your first injection 2 hours prior to surgery. After that, your doctor or a nurse will give you 1 subcutaneous injection once a day while you are in hospital.

    Medical Patients: While you are in the hospital, your doctor or a nurse will give you 1 subcutaneous injection once a day. The usual duration of administration is 6 to 11 days.

    Treatment of Deep Vein Thrombosis, with or without Embolism: while you are in the hospital, your doctor or a nurse will give you 1 subcutaneous injection once or twice daily for about 10 days.

    Treatment of Unstable Angina or Non-Q-Wave Myocardial Infarction: while you are in the hospital, your doctor or a nurse will give you 2 subcutaneous injections every day (one injection every 12 hours) along with oral ASA (100 to 325 mg once daily) for a minimum of 2 days.

    Treatment of acute ST-segment Elevation Myocardial Infarction (STEMI): while you are in the hospital, your doctor or a nurse will give you a single intravenous (IV) injection followed by 2 subcutaneous injections every day (one injection every 12 hours) along with oral ASA (75 to 325 mg once daily) for a minimum of 8 days, unless contraindicated.

    It is possible that after you go home, you may need to continue your injections of LOVENOX for a few days.

    Instructions for self-injection of LOVENOX:

    Your doctor may want you to continue your LOVENOX injections at home for a few days. If so, he or a nurse will show you how to administer your LOVENOX injections before you are released from hospital. It is essential that you follow these instructions exactly. If you have questions, be sure you ask your doctor or nurse to provide the explanations you require.

    Proper subcutaneous (under the skin) injection of LOVENOX is essential to prevent pain and bruising at the injection site.

    When at home, there is nothing for you to prepare. The syringe is pre-filled with the exact amount of drug required. Do not press on the plunger prior to injection.

    LOVENOX solution should be inspected visually for clarity, particulate matter, precipitation, discolouration, and leakage prior to administration. Do not use if solution shows haziness, particulate matter, discolouration or leakage.

    The recommended site for injection is into the fat of the lower abdomen. This should be at least 5 centimeters away from your belly button and out towards your sides.

    Prior to injection, wash your hands and cleanse (do not rub) the selected site for injection with an alcohol swab. Select a different site of lower abdomen for each injection.

    Remove the needle cover by pulling it straight off the syringe. If adjusting the dose is required, the dose adjustment must be done prior to injecting LOVENOX.

    NOTE: To avoid the loss of drug when using the 30 and 40 mg pre-filled syringes, do not expel the air bubble from the syringe before the injection.

    Sit or lie down in a comfortable position and gather a fold of skin with your thumb and forefinger.

    Then holding the needle at a right angle to the skin folded between your thumb and forefinger, insert the needle as far as it will go. Hold the skin fold throughout the injection process. Once the needle has been inserted, the syringe should not be moved. Push the plunger to inject LOVENOX. Be sure the syringe is empty and the plunger is pushed all the way down before removing the syringe.

    Remove the needle at a right angle, by pulling it straight out. A protective sleeve will automatically cover the needle.

    NOTE: The safety system allowing release of the protective sleeve can only be activated when the syringe has been emptied by pressing the plunger all the way down.

    You can now let go of the skin fold and apply light pressure to the skin at the injection site for several seconds with an alcohol swab. This action will help lessen any oozing of LOVENOX or bleeding. Do not rub the injection site.

    You should then safely dispose of the syringe and needle with its protective sleeve, so they remain out of reach of children.

    Overdose:

    Accidental overdosage may result in hemorrhaging, which cannot be treated at home. Therefore, if you suspect that you have used too much LOVENOX, call your doctor immediately even if you do not yet observe any unusual symptoms. Your doctor can then make arrangements to bring you to hospital for observation and/or treatment.

    In case of drug overdose, contact a health care practitioner, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

    Missed dose:

    If you miss a dose of this medication by a few hours, take it as soon as you remember. However if you are close to the time of the next dose, skip the missed dose and proceed with the regular dosing schedule. Do not double doses. If you are unsure about how to proceed contact your doctor or your pharmacist.

    Side Effects

    Administration of LOVENOX may result in bleeding which can have serious or life-threatening consequences. Hemorrhagic strokes (bleeding inside of the brain) and serious intra-abdominal bleeding (bleeding into the body cavity below diaphragm which contains stomach, intestines, liver, and other organs) have been reported. LOVENOX is generally well tolerated when used according to directions of use.

    During your hospital stay or when using LOVENOX at home, it is important that you notify your doctor immediately if you notice any of the following symptoms which may be a sign of an underlying complication:

    • Bleeding or oozing from the surgical wound;

    • Any other bleeding episodes, for example, at the site of the injection, nosebleeds, blood in the urine or if you cough or throw up blood, or have bloody stools;

    • Bleeding gums while brushing teeth;

    • Spontaneous bruising (a bruise not caused by a blow or any apparent reason);

    • Purplish or reddish discolouration or pain around the injection site;

    • Skin discolouration as caused by ruptured blood vessels;

    • Pain or swelling in any part of your leg, foot or hip;

    • Dizziness; headache;

    • Rapid or unusual heart beat;

    • Chest pain or shortness of breath;

    • Vomiting;

    • Confusion;

    • Abdominal pain.

    Talk to you doctor or pharmacist if you experience other side effects such as:

    • Changes in the results of blood tests done to check how your liver is working.during treatment with LOVENOX.

    • Signs of liver problems such as loss of appetite, dark urine, light-colored stools, yellowing of the skin or eyes (jaundice).

    • If you have an allergic reaction. The signs may include: skin rash, angioedema (swelling of lips, face, throat and tongue, breathing difficulties) and anaphylactic/anaphylactoid reactions including shock.

    • Long term use of LOVENOX (greater than 3 months) may increase your risk of bone thinning (osteoporosis).

    • Some patients may experience hair loss. The hair usually grows back once the treatment is discontinued.

    • If you have had a spinal puncture or a spinal anesthetic and notice tingling, numbness and muscular weakness, particularly in the lower part of your body, or if you have problems controlling your bowels and/or bladder.

    For any unexpected effects while taking LOVENOX, contact your doctor or pharmacist.

    Warnings and Precautions

    WHAT YOU SHOULD TELL YOUR DOCTOR BEFORE TREATMENT WITH LOVENOX: It is important that you provide your doctor with an accurate history of any serious illnesses you may have had in the past or any current medical conditions, as these may influence the action of LOVENOX.

    Therefore, tell your doctor if you have had or currently have any of the following conditions:

    • prosthetic (artificial) heart valve,

    • stroke (cerebrovascular accident),

    • a known allergy to LOVENOX or any of its constituents, or to other low molecular weight heparins and/or heparin,

    • thrombocytopenia (a severe decrease in the number of platelets in the blood),

    • bacterial endocarditis (bacterial infection inside of the heart),

    • a major clotting disorder,

    • gastric or duodenal ulcer (defect of the internal walls of the stomach or small intestine),

    • hypertension (high blood pressure),

    • a tendency to bleeding regardless of the reason,

    • injury or surgery (spinal surgery with spinal/epidural anesthesia) involving the central nervous system, eyes or ears,

    • spinal defect (or deformity),

    • kidney problems,

    • liver problems,

    • eye problems due to diabetes or hemorrhage (bleeding).

    You should also inform your doctor at once if you are pregnant or if you are breast-feeding, so he can evaluate the possible risks to you and the infant.

    Certain medications may intensify the anticoagulant effect (increase the anti-clotting effect) of LOVENOX. Therefore, it is important for you to advise your doctor of all drugs that you are presently taking.

    It is necessary that you follow the instructions of your doctor or nurse carefully. Only give yourself the injections prescribed and do so the entire time period specified by your doctor.

    Do not take any drugs other than those prescribed by your doctor while you are taking LOVENOX.

    If you need to consult with another doctor or see your dentist, be absolutely sure to tell them that you are being treated with LOVENOX.

    Interactions with this medication

    LOVENOX should be used with caution in conjunction with other drugs that affect blood clotting. These agents include medication such as:

    • Acetylsalicylic acid (ASA), salicylates, and non-steroidal anti-inflammatories (e.g. diclofenac, ibuprofen, ketorolac);

    • Prednisolone

    • Dextran, vitamin K antagonists, clopidogrel, ticlopidine and dipyridamole.

    Other related products

    The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.