Lovenox (Enoxaparin)

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.

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.

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.