What is Lovenox Uses, warnings & interactions
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Lovenox (enoxaparin) is a low molecular weight heparin (LMWH) that is manufactured by Sanofi-Aventis U.S. It was first approved by the U.S. Food and Drug Administration (FDA) for medical use in 1993. It is used to treat or prevent certain types of blood clots. While it is not approved for use in pediatric patients, it is sometimes used off-label in children or infants with deep vein thrombosis (DVT).
What is Lovenox used for?
Lovenox (enoxaparin) is a blood thinner (anticoagulant) that blocks certain proteins to make blood clots less likely to form. This helps reduce the risk of complications such as heart attacks or strokes. Lovenox is FDA-approved to treat the following conditions:
- Acute coronary syndromes such as ST-elevation myocardial infarction (STEMI), Non-ST elevation myocardial infarction, and unstable angina
- Prophylaxis of blood vessel complications of unstable angina (chest pain) and non–Q-wave myocardial infarction (MI)
- Deep vein thrombosis (DVT) prophylaxis in abdominal surgery, hip replacement surgery, knee replacement surgery, or bedridden patients
- Pulmonary embolism (PE)
- Prevention and treatment of venous thromboembolism (VTE)
- Treatment for prosthetic valve thrombosis in pregnancy
- Percutaneous coronary intervention (PCI)
How does Lovenox work?
Blood clots can form in various parts of the body and cause serious complications such as pulmonary embolism, heart attack, and stroke. Lovenox is a type of low molecular weight heparin (LMWH) that binds and potentiates antithrombin III to irreversibly inactivate clotting factor Xa. By inactivating factor Xa, prothrombin is not activated into thrombin, and fibrinogen is not converted into fibrin. This helps prevent the formation of new blood clots as well as stop existing blood clots from getting bigger or becoming loose while your body dissolves them over time. At therapeutic doses, Lovenox does not significantly affect platelet activity, prothrombin time (PT), or activated partial thromboplastin time (aPTT).
What are the most commonly prescribed doses of Lovenox?
- 30mg/0.3ml single-dose prefilled syringe
- 40mg/0.4ml single-dose prefilled syringe
- 60mg/0.6ml single-dose prefilled syringe
- 80mg/0.8ml single-dose prefilled syringe
- 100mg/1ml single-dose prefilled syringe
- 120mg/0.8ml single-dose prefilled syringe
- 150mg/1ml single-dose prefilled syringe
- 300mg/3ml multiple-dose vial
Before taking Lovenox
Before starting Lovenox, tell your healthcare provider if you have any of the following medical conditions:
- Having a procedure that involves spinal or epidural anesthesia or a spinal puncture
- Have a heart valve
- Infection of the lining of your heart (endocarditis)
- History of stomach ulcers
- History of stroke
- Have high blood pressure
- Recent brain or eye surgery
- Have liver or kidney disease
- High levels of potassium (hyperkalemia)
- Are pregnant, plan on becoming pregnant, or are breastfeeding
How to take Lovenox
- Read the Full Prescribing Information including the Black Boxed Warning, Instructions for Use, and Medication Guide that comes with Lovenox.
- Take Lovenox exactly as your healthcare provider prescribes it to you. Do not change your dose or stop taking this medication without first discussing it with them.
- Lovenox is typically given as a subcutaneous injection (under the skin) in your abdominal wall once a day. Rotate your injection site with each daily dose. You should be sitting or lying down when you give the injection. Your healthcare provider will show you how to administer Lovenox before you give your first dose.
- Lovenox is a clear, colorless to pale yellow solution. Do not use Lovenox if it has changed colors, or has particles in it.
- Use a Lovenox needle and syringe for one use and then place them in a sharps container. Follow your local or state laws on how to dispose of your sharps container.
- Store Lovenox in its original carton or packaging at room temperature between 15°C-30°C (59°F-86°F). Discard any unused Lovenox from the multiple-dose vials 28 days after the first use. Store Lovenox in a cool, well-ventilated, dry place away from direct sunlight.
Lovenox is contraindicated in patients who have any of the following medical conditions:
- Active major bleeding or are at a high risk of bleeding (stomach ulcer, recent brain surgery)
- History of heparin-induced thrombocytopenia (HIT) within the past 100 days or if you have antibodies to Lovenox circulating in your blood
- Allergic reaction to Lovenox, heparin, or pork products
- Allergic reaction to benzyl alcohol (multi-dose vial only)
- Increased risk of hemorrhage. You should be monitored for signs of bleeding.
- Increased risk of thrombocytopenia. Your platelet count should be monitored very closely.
- Increased risk of bleeding around the spinal cord. You are at a higher risk if you have a spinal catheter in place or had one recently removed.
- Increased risk of thrombosis in pregnant females with heart valves. Monitor frequently and adjust the dose if indicated.
- Lovenox is not interchangeable with heparin or other low molecular-weight heparins.
Common side effects of Lovenox
The most common side effects of Lovenox include:
- Anemia (low red blood cell count)
- Injection site reactions
- Elevated liver enzymes
- Shortness of breath
Lovenox can cause serious side effects including:
- Major bleeding (nosebleeds, blood in the urine, bleeding gums, coughing or throwing up blood or what looks like coffee grounds)
- Hypersensitivity reactions, including hives, swelling, and trouble breathing
- Increased risk of hemorrhage
- Epidural or spinal hematomas
- Severe headache
Contact your healthcare provider for medical advice about any side effects you experience while taking Lovenox. You can report your side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Lovenox drug interactions
When Lovenox is taken with other medicines, they may interact and change how they work. They can also change the frequency and severity of side effects. Make sure your doctor is aware of all prescription drugs, over-the-counter medications, vitamins, and herbal supplements you take. Some major drug interactions with Lovenox include:
- Blood thinners or anticoagulants such as Coumadin (warfarin), Plavix (clopidogrel), Eliquis (apixaban), and Persantine (dipyridamole)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Motrin (ibuprofen), and Aleve (naproxen)
- Herbal supplements such as ginkgo biloba, fish oil, and garlic.
There are other medications that your healthcare professional can prescribe if Lovenox is not the right medication for you. Some alternative FDA-approved treatment options include:
How does Lovenox compare with Eliquis (apixaban)?
Lovenox is indicated to treat DVT and pulmonary embolisms in a variety of conditions. It is also used to treat or prevent complications from unstable angina and myocardial infarction. Eliquis is used to reduce the risk of stroke and systemic embolism in patients with nonvalvular AFib. Both have the main side effect of major bleeding and should not be taken with other medications that affect coagulation.
In one study comparing the two medications, the rate of venous thromboembolism (VTE) and VTE-related death after 30 days was not significantly lower in the Eliquis group when compared to patients on Lovenox. Major bleeding was low in both groups but was higher in Eliquis patients compared to Lovenox patients.
Two other studies that looked at thromboprophylaxis with these 2 medications found that Eliquis was found to have lower rates of VTE without increased bleeding.
There is currently no generic alternative available for Eliquis but there is one available for Lovenox. Generic Lovenox has an average cost of about $650 for #12, 40mg/0.4ml prefilled syringes while Eliquis costs approximately $600 for #60, 5mg tablets.
How long does Lovenox stay in your system?
Lovenox has a half-life of 4.5 to 7 hours, so it will stay in your bloodstream for about 1.5 days after your last dose.
How do I store Lovenox?
Store Lovenox in its original carton or packaging at room temperature between 15°C-30°C (59°F-86°F). Discard any unused Lovenox from the multiple-dose vials 28 days after the first use. Store Lovenox in a cool, well-ventilated, dry place away from direct sunlight.
How long does it take for Lovenox to start working?
After subcutaneous injection, Lovenox starts to work within 2 hours and its effects last up to 12 hours.
Can you take Lovenox while you are pregnant or breastfeeding?
Lovenox is considered a Pregnancy Category B. Lovenox does not cross the placenta in pregnant women and is not expected to cause drug exposure to the fetus. It is not known whether Lovenox is found in breast milk or the effects it may have on the infant. You should always discuss the risks and benefits of any medication with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.
Will lab monitoring be done when taking Lovenox?
You should have blood tests to check for high potassium or low platelet levels. You should be monitored closely for signs and symptoms of bleeding. Anti-Factor Xa may also be used to monitor the anticoagulant effect of Lovenox in patients with significant kidney impairment. Your dose will need to be adjusted if your creatinine clearance is less than 30 ml/minute.
Is there a generic for Lovenox?
Currently, there is a generic for Lovenox available on the market. However, you may still pay less for the brand-name drug Lovenox through NiceRx if eligible for assistance.
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.