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Terms Of Use

ENOXAPARIN SODIUM

Brand Name(s) : Clexane
Warnings
Uses
Side Effects
Precautions
Interactions
Overdose

ENOXAPARIN SODIUM WARNINGS

Enoxaparin should be used with caution in:

  • The elderly (especially those over 75 years old)
  • People having spinal and epiduralanaesthesia during an operation or a spinal puncture due to a risk of intraspinal bruising (extra care must be taken with the timing of doses)
  • People with severe kidney problems
  • People with a history of peptic ulcer
  • People with high blood pressure
  • People with damage to the retina of the eye caused by diabetes (diabetic retinopathy)
  • People with recent brain, spinal or eye surgery
  • People with diabetes
  • People with metabolic problems (increased acidity, raised potassium levels)
  • People with artificial replacement heart valves
  • Pregnant women
  • Breast feeding women
  • People with low body weight
  • People receiving certain medications including other medications to prevent blood clotting (see interactions)

It should not be used in:

  • People with a known hypersensitivity (allergy) to enoxaparin sodium or other low molecular weight heparins and/or heparins
  • Children
  • Pregnant women with artificial replacement heart valves
  • People with an active intestinal ulcer (peptic or duodenal ulcer)
  • People who have had a stroke caused by bleeding
  • People who have bleeding in the brain (cerebral haemorrhage)
  • People with a high tendency to bleed (e.g. due to haemophilia or severe liver failure)
  • People who bleed and bruise easily due to a low platelet count (thrombocytopenia)
  • People with severe high blood pressure (hypertension)
  • People with certain heart problems (inflammation of the heart lining and valves-endocarditis)
  • People taking local and/or regional anaesthesia in elective surgical procedures (for treatment of clots, not prevention)

Also see list of precautions and interactions

STORAGE

Do not store above 25°C. Do not refrigerate or freeze.

ENOXAPARIN SODIUM USES

What is it used for?

  • Enoxaparin is used to prevent and treat abnormal blood clotting.
  • It is a low molecular weight heparin, sometimes known as an anti-thrombotic or blood thinning drug.
  • It is used to prevent and treat blood clotting.
    Blood clots may develop in the legs (deep vein thrombosis) or in the lungs (pulmonary embolism) usually after operations, after prolonged bed rest, in pregnancy or in some types of cancer. Enoxaparin is also used to treat heart attacks and prevent a heart attack in people with poor blood flow to the heart due to furring up of the arteries (unstable angina).
  • In general this drug is used to treat blood clots and to prevent blood clots forming particularly those associated with general or orthopaedic (bone) surgery and people bedridden due to illness.
  • Benefits of being on this drug can include successful prevention and treatment of life threatening blood clots.

Listed below are the typical uses of enoxaparin.

  • Prevention and treatment of blood clots in the deep veins of the leg (deep vein thrombosis), or in the lung (pulmonary embolism) or both
  • Prevention of blood clots in the equipment of the dialysis machine during kidney dialysis
  • Treatment of a heart attack (non Q wave myocardial infarction)
  • Treatment of heart blood flow problems (unstable angina)

On occasion your doctor may prescribe this medicine to treat a condition not on the above list.

HOW TO USE/TAKE

Enoxaparin is available as a solution for injection in prefilled syringes and as multidose vials.

How often do I take it?

  • Enoxaparin will be given to you as an injection, usually by a nurse or doctor. The injection is usually given as a small injection under your skin, usually once daily (for prevention and treatment of clots) or twice daily (for angina and heart attacks). You may also be shown how to give yourself the injection at home. Directions for the use of enoxaparin are given in the Patient Information Leaflet. Treatment for unstable angina and heart attack is given with aspirin.
  • It may take up to 30 minutes before the full benefit of this drug takes effect.
  • Certain medical conditions may require different dosage instructions as directed by your doctor.

What dose?

  • Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.

Do I need to avoid anything?

  • Enoxaparin is not known to affect the ability to drive or operate machinery. Consult your doctor or pharmacist for more details.

When can I stop?

  • The doctor will normally stop or tell you when to stop using this medication. Keep taking until your doctor tells you to stop otherwise you could get a blood clot which can be very serious.
  • Treatment for unstable angina and heart attacks is given for a minimum of 2 days and continued until you are stabilised. The usual duration of treatment is 2 to 8 days.

ENOXAPARIN SODIUM SIDE EFFECTS

  • Low platelet count (reversible type 1 thrombocytopenia), which may make you bruise more easily
  • Bleeding at any site in the body
  • Bruising at the injection site
  • Abnormal blood tests - Increases in liver enzymes in the blood
  • Abnormal blood tests - Increases in the blood potassium level, which may cause muscle weakness
  • Weak bones (osteoporosis)
  • Pain at the injection site
  • Allergic reactions including rash, hives and itching
  • Skin lesions due to death of skin cells (rare side effect)
  • Very low platelet count (type 2 thrombocytopenia due to problems with your immune system; rare side effect)
  • Bleeding and bruising in the spine leading to back pain, numbness or weakness in your legs, and bowel and bladder control problems.

If any of these persist or you consider them severe then inform your doctor.

Tell your doctor immediately if you develop any of the following symptoms:

  • Back pain, numbness or weakness in your legs, and bowel and bladder control problems (if you have had spinal and epidural anaesthesia during an operation or a spinal puncture)
  • Bleeding
  • Sudden severe headache
  • Painful, dark red spots on your skin

Tell your doctor as soon as possible if you develop any of the following symptoms:

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.

ENOXAPARIN SODIUM PRECAUTIONS

Before taking enoxaparin, tell your doctor or pharmacist if you are allergic to it; or to any other heparins; or if you have any other allergies.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist in case of:

  • People with a known hypersensitivity (allergy) to enoxaparin sodium or other low molecular weight heparins and/or heparins
  • An active intestinal ulcer (peptic or duodenal ulcer)
  • A stroke caused by bleeding
  • Bleeding in the brain (cerebral haemorrhage)
  • Severe high blood pressure (hypertension)
  • A high tendency to bleed (e.g. due to haemophilia or severe liver failure)
  • A low platelet count in the blood (thrombocytopenia) and bleed and bruise easily due to a low platelet count (thrombocytopenia)
  • Certain heart problems (inflammation of the heart lining and valves-endocarditis)

Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following:

  • Severe kidney problems
  • Previous peptic ulcer
  • High blood pressure
  • Damage to the retina of the eye caused by diabetes (diabetic retinopathy)
  • Recent brain, spinal or eye surgery
  • Diabetes
  • Metabolic problems (increased acidity, raised potassium levels)
  • An artificial replacement heart valve
  • Low body weight
  • If you are going to have spinal and epidural anaesthesia during an operation or a spinal puncture

Before having surgery, tell your doctor or dentist that you are taking this medication.

Does alcohol intake affect this drug?

  • Alcohol intake is not known to affect enoxaparin.

The elderly: enoxaparin can be used in the elderly. Elderly people, particularly those over 75 years old may be at an increased risk of bleeding.

Pregnancy and breastfeeding - please ensure you read the detailed information below

PREGNANCY

Enoxaparin in women with artificial replacement heart valves is not safe to take if you are, or are planning to become, pregnant.

The safety of enoxaparin has not been established during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.
Second trimester: Not known to be harmful

It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.

If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.

BREAST FEEDING

It is not known whether enoxaparin passes into breast milk. The manufacturer therefore states that it should not be taken if you are breastfeeding.

It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.

If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.

ENOXAPARIN SODIUM INTERACTIONS

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:

  • Heparin used to treat blood clots

If you are currently using such medications, tell your doctor or pharmacist before starting enoxaparin.

Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:

  • Diuretics (water tablets) used to treat high blood pressure and heart failure- some types such as spironolactone and amiloride which increase the blood potassium level
  • Glucocorticoids (systemic) such as dexamethasone and prednisolone used to treat asthma and inflammatory conditions
  • Medications known as non-steroidal anti-inflammatory drugs (NSAIDs) such as indometacin, diclofenac, ibuprofen and ketorolac (used to treat pain and inflammation)
  • Other medications that thin the blood and prevent blood clots (antiplatelet dugs and oral anticoagulants) such as aspirin, clopidogrel, dipyridamole and warfarin
  • Plasma substitutes such as dextrans used to increase blood volume
  • Salicylates (systemic) such as aspirin to treat rheumatic pain
  • Thrombolytic medications for treating a heart attack

The above medications are best avoided and enoxaprin should only be used with them with careful clinical and laboratory monitoring.

This information does not contain all possible interactions. Therefore, before using enoxaparin, tell your doctor or pharmacist of all the products you use.

ENOXAPARIN SODIUM OVERDOSE

Taking too much enoxaparin, may cause the following: bleeding and bruising easily.

If you feel that you have taken more enoxaparin than you should, inform your doctor or nursing staff immediately- even if you have no signs of a problem.
People who have taken too much enoxaparin may be given protamine by intravenous injection over approximately 10 minutes in an emergency.

If you think you, or someone you care for, might have accidentally taken more than the recommended dose of enoxaparin or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.

MISSED DOSE

A doctor or nurse will normally be in charge of your dosing schedule.

If you are dosing at home and you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

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Source: Selected from data included with permission and copyrighted by Boots UK Limited or TicTac Communications Ltd. This copyrighted material is sourced from a licensed data provider and is not for distribution, except as may be authorised by the applicable terms of use.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgement of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse events, nor should it be construed to indicate that use of a particular medicine is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any medicine, changing any diet, or discontinuing any course of treatment.

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