enoxaparin
Enoxaparin (Lovenox) is a blood thinner that's used to treat and prevent blood clots and other clotting-related conditions. It's given as an injection under the skin in the stomach. The dosing for enoxaparin (Lovenox) depends mostly on your weight, but also on why you need the medication. Enoxaparin (Lovenox) is a preferred choice for pregnant women, but it might not be the best option if they have prosthetic (artificial) heart valves. Side effects aren't common, but can include bleeding or bruising at the injection site. Enoxaparin (Lovenox) is available as a brand and generic medication.
What is Enoxaparin (Lovenox)?
What is Enoxaparin (Lovenox) used for?
- Prevention of blood clots in the arms or legs (deep vein thrombosis or DVT) or in the lungs (pulmonary embolism or PE) in:
- People having stomach, hip, or knee surgery
- People who aren't able to move well
- People with a certain type of chest pain called unstable angina
- Treatment of blood clots
- Heart attack
How Enoxaparin (Lovenox) works
Enoxaparin (Lovenox) is an anticoagulant (or blood thinner). It blocks certain proteins in your blood that are responsible for forming blood clots. This helps prevent blood clots from getting bigger and new blood clots from forming.
Drug facts
More on Enoxaparin (Lovenox) essentials
Side effects of Enoxaparin (Lovenox)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Abnormal liver tests (6%)
- Major bleeding (up to 4%)
Less Common Side Effects
- Bleeding, bruising, redness, or pain at injection site
- Low red blood cell count (anemia)
- Bruising
- Swelling
- Fever
Enoxaparin (Lovenox) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe bleeding: feeling faint, lightheadedness, dizziness, vomiting blood, bloody or dark-colored stools, severe stomach pain or discomfort
- Heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia with thrombosis (HITT): skin changes or bruising, shortness of breath, chest pain or tightness, trouble speaking, numbness on one side of your body, vision problems
- Serious allergic reaction: rash; trouble breathing; swelling of the lips, tongue, or face; vomiting; chills; fever
- Blood clots due to stopping enoxaparin (Lovenox) too soon: in leg or arm (e.g., swelling or redness in arms or legs, skin that's warm to touch); in lungs (e.g., trouble breathing, chest pain, cough, irregular heartbeat)
More on Enoxaparin (Lovenox) side effects
The following Enoxaparin (Lovenox) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Bleeding gums
coughing up blood
difficulty with breathing or swallowing
dizziness
headache
increased menstrual flow or vaginal bleeding
nosebleeds
paralysis
prolonged bleeding from cuts
red or black, tarry stools
red or dark brown urine
shortness of breath
Less common
Bruising
chest discomfort
collection of blood under the skin
confusion
continuing bleeding or oozing from the nose and/or mouth, or surgical wound
convulsions (seizures)
irritability
lightheadedness
lower back pain
pain or burning while urinating
swelling of the hands or feet
tightness in the chest
uncontrolled bleeding at the site of injection
vomiting of blood or material that looks like coffee grounds
Rare
Back pain
burning, pricking, tickling, or tingling sensation
chills
decreased urine output
dilated neck veins
dizziness or lightheadedness when getting up suddenly from a lying or sitting position
extreme fatigue
fainting
fast or irregular heartbeat
general feeling of discomfort or illness
irregular breathing
leg weakness
problems with bowel or bladder function
skin rash or hives
sudden fainting
swelling of the face, fingers, feet, genitals, mouth, or tongue
thickening of the bronchial secretions
troubled breathing
Incidence not known
Abdominal or stomach pain
deep, dark purple bruise
hives or welts
irregular heartbeat
itching, pain, redness, or swelling
large, flat, blue, or purplish patches in the skin
nausea or vomiting
nervousness
numbness or tingling in the hands, feet, or lips
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness of the skin
skin rash
unusual tiredness or weakness
weakness or heaviness of the legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Enoxaparin (Lovenox)
Pros
- Works well to treat several types of blood-clotting problems
- Safe to use during pregnancy (except those with prosthetic heart valves)
- Possible medication available that might help work as an antidote (reversal agent) to reverse effects
- Blood tests are available to check how well the medication is working, but they're not required
Cons
- Only available as an injection, which can be uncomfortable
- Might be difficult for some people to inject at home
- Might not be a good option for people with kidney problems
- Can cause a serious low platelet condition called heparin-induced thrombocytopenia (HIT)
Pharmacist tips for Enoxaparin (Lovenox)
- Mark your appointments on your calendar to see your provider. Also, set reminders for when your enoxaparin (Lovenox) doses are due. This makes sure you're being properly monitored and also helps you remember to receive your treatments on time.
- Make sure to tell your providers about any medications you're taking before you start enoxaparin (Lovenox), especially if you take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen (Advil), naproxen (Aleve)). These medications can raise your risk for bleeding.
- Let your surgeon or dentist know that you're taking enoxaparin (Lovenox) before any surgery or procedure is scheduled. This medication can raise your risk for bleeding. Your provider might give you specific instructions around the time of your scheduled procedure about when to stop using enoxaparin (Lovenox) to prevent serious bleeding complications.
- Enoxaparin (Lovenox) can make it easier for you to bruise or bleed. It can also make it take longer for your body to stop any bleeding. Call your provider if you have any unusual bleeding (e.g., blood in urine or stool, coughing up blood, vomiting blood) or bruising while taking this medication.
- Get medical help right away if you fall and hit your head hard, especially if you also feel dizzy or have a severe headache. You might need a head scan to see whether you have a brain bleed.
More tips for using enoxaparin (Lovenox) at home:
- Your provider might allow you to give yourself enoxaparin (Lovenox) injections under your skin at home. Carefully read the directions for use or watch the instructional video so you can give yourself the injections safely and properly.
- Make sure you know which strength and dose of enoxaparin (Lovenox) you have to prevent medication errors because enoxaparin (Lovenox) comes in many different strengths. Contact your provider or pharmacist if you're not sure of your dose.
- Inject enoxaparin (Lovenox) into the fat tissue under the skin of your stomach at least 2 inches away from your belly button. Always choose a different injection site for each dose. Repeated injections to the same area can cause pain and damaged skin. Never inject enoxaparin (Lovenox) into your muscle or vein.
- Before injecting enoxaparin (Lovenox), always check to make sure the medication is clear and colorless to a pale yellow. If it's cloudy, discolored, or has many particles (solid chunks), don't use it. Contact your provider or pharmacist to see whether it's possible to get a replacement.
- Throw away each enoxaparin (Lovenox) prefilled syringe after using. Each prefilled syringe provides a single dose of medication, and they don't contain any preservatives to keep germs out of the medication once they're opened.
- If you're prescribed the 300 mg/3 mL vial of enoxaparin (Lovenox), it's good for 28 days after you first use it. Mark the date on the vial when you should throw it away. This vial contains enough medication for multiple doses of enoxaparin (Lovenox) that you'll need to draw up into a syringe as directed by your provider.
- Throw away used syringes and needles in a sharps container or something made of heavy-duty plastic (e.g., empty milk carton, laundry detergent bottle). This lowers the risk of needle-stick injuries. Don't throw them away in your trash can. Learn more about how to throw away your sharps on the FDA's website.
- Store enoxaparin (Lovenox) at room temperature. Don't put the medication into the refrigerator.
Common questions about Enoxaparin (Lovenox)
Inject enoxaparin (Lovenox) under the skin of your stomach at least 2 inches from the left or right of your belly button. You should alternate injection sites each time you give yourself a dose to avoid pain or damage to your skin. Never inject enoxaparin (Lovenox) through clothes or into skin that has bruises or scars; your body might not absorb the medication well so it might not work as well to prevent or treat blood clots.
In general, enoxaparin (Lovenox) can stay in your system for up to 35 hours after you stop taking the medication, but it could be longer if you have kidney problems. Keep in mind that this time frame is estimated based on the half-life of enoxaparin (Lovenox), a measure of how long it takes your body to remove the medication from your system.
Yes, enoxaparin (Lovenox) is a blood thinner (anticoagulant). This means that it prevents your blood from clotting together. As a result, it can raise your risk for bleeding. Stop taking enoxaparin (Lovenox) and get medical help right away if you feel lightheaded, dizzy, you vomit or cough up blood, or you have blood in your stool. These are signs of bleeding that might be happening in your body.
No. "Heparin" typically refers to another medication called unfractionated heparin. Enoxaparin (Lovenox) is a type of low-molecular-weight heparin. It has a slightly different chemical structure than unfractionated heparin that allows it to have longer-lasting effects. While both medications are injectable blood thinners that prevent or treat blood clots, they're FDA-approved for slightly different clotting problems. For example, enoxaparin (Lovenox) is approved for heart attacks, but unfractionated heparin is approved for preventing clots in people with atrial fibrillation (AFib). In addition, enoxaparin (Lovenox) is typically given once or twice per day, whereas unfractionated heparin is given more frequently or by continuous infusion. Finally, enoxaparin (Lovenox) doesn't require routine blood tests for monitoring, but unfractionated heparin does. Talk to your provider to learn more about how both medications compare.
Enoxaparin (Lovenox) shouldn't be injected into a muscle because doing so can cause a painful bruise. If you've accidentally injected enoxaparin (Lovenox) into a muscle, contact your provider for further instructions.
No, enoxaparin (Lovenox) doesn't typically affect INR. But a recent study showed that it might in people receiving enoxaparin (Lovenox) after certain stomach and intestinal surgeries. The international normalized ratio (INR) is a blood test that tells how well your blood can clot. This test is specific for measuring how well a different blood thinner called warfarin (Coumadin) works, not enoxaparin (Lovenox). Instead, a blood test that can be used to measure how well enoxaparin (Lovenox) is working is the anti-factor Xa blood test.
No, keep enoxaparin (Lovenox) at room temperature in the original packaging until you're ready to use the medication. Don't place enoxaparin (Lovenox) in the refrigerator or in the freezer.
Yes, enoxaparin (Lovenox) is generally safe to use during pregnancy because it doesn't reach the unborn baby through the placenta. But it shouldn't be used in pregnant women who have a prosthetic heart valve(s) because of the risk for dangerous blood clots on the valve(s). To be safe, make sure to tell your provider if you're pregnant or thinking of becoming pregnant before starting enoxaparin (Lovenox).
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Risks and warnings for Enoxaparin (Lovenox)
Enoxaparin (Lovenox) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of bleeding around the spinal cord during other injections near the spine
- Risk factors: Lumbar puncture (spinal tap) | Getting anesthesia near the spine (epidural or spinal anesthesia) | History of spinal surgery, spinal taps, spine problems, or epidurals | Taking nonsteroidal anti-inflammatory drugs (NSAIDs) or other blood thinners
You're at a greater risk of bleeding around your spinal cord if you're taking enoxaparin (Lovenox) and need to have a lumbar puncture (spinal tap) or an epidural. Sometimes, this spinal bleeding can make you paralyzed. To lower this risk, your provider will tell you when to stop taking enoxaparin (Lovenox) before your planned back surgery or procedure. If it's not possible, make sure to be aware of the signs and symptoms of spinal problems. Call your provider right away if you notice pain along your spine; tingling, a burning sensation, numbness, or weakness in your legs; or are unable to urinate or have bowel movements.
Risk of bleeding
- Risk factors: Taking other medications that raise the risk for bleeds | History of bleeding problems | Kidney problems | Eye problems related to diabetes | Recent stomach ulcer | Severe high blood pressure
Taking enoxaparin (Lovenox) can raise your risk for bleeds. Your risk is higher if you're also taking other medications that can cause bleeding. If you do have a serious bleed from enoxaparin (Lovenox) use, your provider might be able to give you a medication called protamine to help reverse the effects of enoxaparin (Lovenox). Let your provider know if you have a fall, head injury, or other kinds of physical injury. They might need to check you for bleeding inside your body. Get medical help right away if you have dark or tarry stool, bleeds that are difficult to stop, or any unusual bleeding or bruising.
Low platelet counts and clotting problems
- Risk factors: Recent history of heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia with thrombosis (HITT)
Enoxaparin (Lovenox) works similarly to heparin. Like heparin, enoxaparin (Lovenox) can cause your platelet counts to go down. In rare cases, a low platelet count can occur along with a life-threatening condition called heparin-induced thrombocytopenia (HIT). HIT happens when the immune system makes antibodies that affect how platelets function. This can cause blood clots to form in various parts of the body and lead to blockages in your veins or arteries, a condition called heparin-induced thrombocytopenia with thrombosis (HITT).
Make sure you keep up with your lab work so your provider can keep track of your platelet counts. If your platelets become very low or if you experience any blood clots during or after treatment, your provider will probably stop enoxaparin (Lovenox) and consider a different blood thinner for you if needed. Get medical help right away if you experience any symptoms of blood clots during or after enoxaparin (Lovenox) treatment.
Higher risk of clots in pregnant women with prosthetic heart valves
Pregnant women with prosthetic (artificial) heart valves who are taking enoxaparin (Lovenox) are at higher risk for blood clots that form on the heart valves. This lead sometimes lead to dangerous complications in the mother and baby. If you have a prosthetic heart valve and are pregnant, your provider might require you to get more frequent visits and lab tests to make sure enoxaparin (Lovenox) is working appropriately and safely.
Risk of serious breathing problem in infants (gasping syndrome)
- Risk factors: Newborns | Infants with low birth weight | Pregnant women | Breastfeeding
Benzyl alcohol is one of the preservatives found in certain enoxaparin (Lovenox) products. This preservative can cause a rare, but serious and sometimes life-threatening medical condition called gasping syndrome. This condition is more likely to happen in newborns and infants with low birth weight. If you're pregnant or breastfeeding, talk with your provider before receiving enoxaparin (Lovenox), since your baby could potentially be exposed to benzyl alcohol in the womb or through your breast milk. Your provider can make sure you receive a preservative-free formulation of the medication.
Tell your provider if your child experiences any major weight changes while receiving enoxaparin (Lovenox). Get medical attention right away if your child has symptoms, such as gasping, slowed heart rate, clammy skin, dizziness, seizures, slurred speech, or weakness in an arm or leg.
Enoxaparin (Lovenox) dosage
Syringe| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 120mg/0.8ml | 8 syringes | $86.69 | $10.84 |
| 150mg/ml | 10 syringes | $107.30 | $10.73 |
| 100mg/ml | 10 syringes | $58.41 | $5.84 |
| 80mg/0.8ml | 8 syringes | $51.12 | $6.39 |
| 60mg/0.6ml | 36 syringes | $107.09 | $2.97 |
| 40mg/0.4ml | 12 syringes | $42.28 | $3.52 |
| 30mg/0.3ml | 9 syringes | $38.67 | $4.30 |
Vial| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 3ml of 300mg | 1 vial | $21.81 | $21.81 |
Typical dosage for Enoxaparin (Lovenox)
The dose and length of treatment depends on your age, weight, kidney function, and why you need enoxaparin (Lovenox). The dose might also depend on certain lab test results, including complete blood count (CBC) and those measuring how long it takes for your blood to clot.
In general, enoxaparin (Lovenox) is typically given as an injection under the skin (subcutaneous or SC). Manufacturer dosages for enoxaparin (Lovenox) are listed below.
- Prevention of blood clots: The typical dose is either 30 mg injected under the skin every 12 hours or 40 mg under the skin once daily.
- Prevention of blood clots in people with unstable angina: The typical dose is 1 mg/kg of weight injected under the skin every 12 hours. It's taken along with aspirin.
- Treatment of blood clots: The typical dose is 1 mg/kg of weight injected under the skin every 12 hours or 1.5 mg/kg under the skin once daily. If your provider decides to switch you to warfarin (Coumadin), you'll take both enoxaparin (Lovenox) and warfarin (Coumadin) for at least 5 days and until your INR level is in the appropriate range.
- Heart attack: In general, the typical dose is 1 mg/kg of weight injected under the skin every 12 hours, taken along with aspirin. For the treatment of certain types of heart attack, the first dose is 30 mg of enoxaparin (Lovenox) as an injection through the veins (intravenous, IV) with 1 mg/kg given as an injection under the skin.
More on Enoxaparin (Lovenox) dosage
Interactions between Enoxaparin (Lovenox) and other drugs
More on Enoxaparin (Lovenox) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Defibrotide
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Aceclofenac
- Acemetacin
- Acenocoumarol
- Alipogene Tiparvovec
- Alteplase, Recombinant
- Amtolmetin Guacil
- Anagrelide
- Anistreplase
- Antithrombin, Recombinant
- Apixaban
- Argatroban
- Bemiparin
- Betrixaban
- Bivalirudin
- Bromfenac
- Bufexamac
- Caplacizumab-yhdp
- Celecoxib
- Choline Salicylate
- Citalopram
- Clonixin
- Clopidogrel
- Collagenase, Clostridium histolyticum
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Desvenlafaxine
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyridamole
- Dipyrone
- Drotrecogin Alfa
- Droxicam
- Edoxaban
- Eptifibatide
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Heparin
- Ibrutinib
- Ibuprofen
- Ibuprofen Lysine
- Iloprost
- Indomethacin
- Inotersen
- Ketoprofen
- Ketorolac
- Lepirudin
- Levomilnacipran
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Morniflumate
- Nabumetone
- Nadroparin
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Nintedanib
- Omadacycline
- Orlistat
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Paroxetine
- Pentosan Polysulfate Sodium
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Piketoprofen
- Piracetam
- Piroxicam
- Prasugrel
- Proglumetacin
- Propionic Acid
- Propyphenazone
- Proquazone
- Reteplase, Recombinant
- Rivaroxaban
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sarecycline
- Sertraline
- Sodium Salicylate
- Streptokinase
- Sulfinpyrazone
- Sulindac
- Tenecteplase
- Tenoxicam
- Tiaprofenic Acid
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Trazodone
- Treprostinil
- Urokinase
- Valdecoxib
- Venlafaxine
- Vilazodone
- Vorapaxar
- Vortioxetine
- Warfarin
How much does Enoxaparin (Lovenox) cost?
Enoxaparin (Lovenox) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Enoxaparin (Lovenox) will not be safe for you to take.
- Uncontrolled bleeding
- History of heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia with thrombosis (HITT)
- Allergy to heparin
- Allergy to pork
- Allery to benzyl alcohol (an ingredient used as a preservative)
What are alternatives to Enoxaparin (Lovenox)?
News about Enoxaparin (Lovenox)
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