Enoparin
Generic Name
Enoxaparin Sodium 8000 anti-Xa IU (80 mg) injection
Manufacturer
Various Pharmaceutical Companies (e.g., Sanofi as original developer)
Country
Global / Various
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| enoparin 8000 anti xa injection | ৳ 630.00 | N/A |
Description
Overview of the medicine
Enoxaparin is a low molecular weight heparin (LMWH) used to prevent and treat various thromboembolic disorders, including deep vein thrombosis (DVT) and pulmonary embolism (PE). It also finds use in the management of unstable angina and myocardial infarction.
Uses & Indications
Dosage
Adults
For DVT/PE treatment: 1 mg/kg (100 anti-Xa IU/kg) every 12 hours or 1.5 mg/kg (150 anti-Xa IU/kg) once daily, administered subcutaneously. For unstable angina/NSTEMI: 1 mg/kg every 12 hours subcutaneously, usually given with aspirin. For STEMI: 30 mg IV bolus plus 1 mg/kg SC (max 100 mg for first two SC doses) every 12 hours. The 80 mg (8000 anti-Xa IU) dose would be administered based on weight for treatment indications.
Elderly
No general dose reduction for the elderly, but careful monitoring for bleeding and renal function is advised. For patients ≥75 years with STEMI, no initial IV bolus, begin with 0.75 mg/kg SC every 12 hours (max 75 mg for first two SC doses).
Renal_impairment
For severe renal impairment (CrCl < 30 mL/min), dose adjustment is necessary. For DVT/PE treatment: 1 mg/kg (100 anti-Xa IU/kg) once daily. For prophylaxis: 30 mg (3000 anti-Xa IU) once daily.
How to Take
Administer by deep subcutaneous injection, alternating injection sites (e.g., left and right anterolateral or posterolateral abdominal wall). Do not expel the air bubble from pre-filled syringes before injection. Do not inject intramuscularly. For STEMI, an initial IV bolus is given before the first subcutaneous dose.
Mechanism of Action
Enoxaparin exerts its anticoagulant effect primarily by potentiating the inhibitory action of antithrombin III on Factor Xa. It has a relatively lower effect on thrombin (Factor IIa) compared to unfractionated heparin, resulting in a more predictable anticoagulant response.
Pharmacokinetics
Onset
Peak anti-Xa activity within 3-5 hours after SC injection.
Excretion
Primarily renal; about 40% of the anti-Xa activity is excreted in the urine as active and inactive fragments.
Half life
Approximately 4.5-7 hours (anti-Xa activity) after a single subcutaneous dose, extending in patients with renal impairment.
Absorption
Rapid and complete after subcutaneous (SC) injection; bioavailability is approximately 100%. Peak anti-Xa activity is achieved within 3-5 hours.
Metabolism
Partially desulfated and depolymerized in the liver to lower molecular weight species with reduced biological potency.
Side Effects
Contraindications
- Active major bleeding or conditions with high risk of uncontrolled hemorrhage (e.g., active ulceration, recent hemorrhagic stroke).
- History of heparin-induced thrombocytopenia (HIT) with or without thrombosis in the past 100 days or presence of circulating anti-platelet antibodies.
- Hypersensitivity to enoxaparin, heparin, or pork products.
- Spinal/epidural anesthesia or lumbar puncture in patients receiving enoxaparin for treatment doses, or within 24 hours of prophylaxis doses.
Drug Interactions
Thrombolytic agents
Significantly increased risk of hemorrhage.
Anticoagulants (e.g., warfarin, dabigatran, rivaroxaban)
Increased risk of bleeding. Close monitoring and careful dose adjustment are necessary.
Antiplatelet agents (e.g., aspirin, clopidogrel, NSAIDs)
Increased risk of bleeding. Concurrent use should be approached with caution.
Storage
Store at room temperature (20°C to 25°C, 68°F to 77°F). Excursions permitted to 15°C to 30°C (59°F to 86°F). Do not freeze. Protect from light.
Overdose
Accidental overdose may lead to hemorrhagic complications. The anticoagulant effects can be largely neutralized by the slow intravenous injection of protamine sulfate. The dose of protamine sulfate should be carefully titrated based on the administered enoxaparin dose and the time since administration.
Pregnancy & Lactation
Pregnancy Category B. Enoxaparin does not cross the placental barrier. Generally considered safe for use during pregnancy when indicated, especially for thromboprophylaxis. Excreted into breast milk in very low amounts, unlikely to cause harm to a nursing infant. Consult a doctor for individualized risk-benefit assessment.
Side Effects
Contraindications
- Active major bleeding or conditions with high risk of uncontrolled hemorrhage (e.g., active ulceration, recent hemorrhagic stroke).
- History of heparin-induced thrombocytopenia (HIT) with or without thrombosis in the past 100 days or presence of circulating anti-platelet antibodies.
- Hypersensitivity to enoxaparin, heparin, or pork products.
- Spinal/epidural anesthesia or lumbar puncture in patients receiving enoxaparin for treatment doses, or within 24 hours of prophylaxis doses.
Drug Interactions
Thrombolytic agents
Significantly increased risk of hemorrhage.
Anticoagulants (e.g., warfarin, dabigatran, rivaroxaban)
Increased risk of bleeding. Close monitoring and careful dose adjustment are necessary.
Antiplatelet agents (e.g., aspirin, clopidogrel, NSAIDs)
Increased risk of bleeding. Concurrent use should be approached with caution.
Storage
Store at room temperature (20°C to 25°C, 68°F to 77°F). Excursions permitted to 15°C to 30°C (59°F to 86°F). Do not freeze. Protect from light.
Overdose
Accidental overdose may lead to hemorrhagic complications. The anticoagulant effects can be largely neutralized by the slow intravenous injection of protamine sulfate. The dose of protamine sulfate should be carefully titrated based on the administered enoxaparin dose and the time since administration.
Pregnancy & Lactation
Pregnancy Category B. Enoxaparin does not cross the placental barrier. Generally considered safe for use during pregnancy when indicated, especially for thromboprophylaxis. Excreted into breast milk in very low amounts, unlikely to cause harm to a nursing infant. Consult a doctor for individualized risk-benefit assessment.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years, refer to product packaging for the specific expiry date.
Availability
Hospitals, retail pharmacies
Approval Status
FDA Approved (for Enoxaparin); DGDA Approved (for various brands)
Patent Status
Patents expired, generic versions available
WHO Essential Medicine
YesClinical Trials
Enoxaparin has undergone extensive clinical trials supporting its efficacy and safety in various indications, including studies like the ENOXAC Trial (for acute coronary syndromes) and MEDENOX (for medical patients with acute illness).
Lab Monitoring
- Complete Blood Count (CBC) including platelet count (before treatment and regularly during treatment, especially between days 5 and 14).
- Renal function (creatinine clearance) at baseline and periodically.
- Anti-Factor Xa levels (recommended for certain patient populations, e.g., renal impairment, obesity, pregnancy, or inadequate clinical response).
- Stool occult blood tests.
Doctor Notes
- Closely monitor patients for signs of bleeding, especially those with increased risk factors (e.g., concomitant use of antiplatelets, renal impairment).
- Consider anti-Xa level monitoring in specific populations (e.g., severe renal impairment, obesity, pregnancy, or if clinical response is unclear).
- Educate patients on proper injection technique and to immediately report any unusual bleeding or neurological symptoms.
- Caution with neuraxial procedures due to the risk of spinal/epidural hematoma.
Patient Guidelines
- Report any unusual bleeding, bruising, red spots on skin, dark stools, or signs of allergic reactions immediately to your doctor.
- Do not take other blood-thinning medications or NSAIDs (e.g., ibuprofen, naproxen) without consulting your doctor or pharmacist.
- If self-administering, ensure proper subcutaneous injection technique and rotate injection sites.
- Inform all healthcare providers, including dentists, about your enoxaparin use before any procedure or surgery.
Missed Dose Advice
If a dose is missed, administer it as soon as possible, then resume the regular schedule. Do not double the dose to catch up. Consult a doctor or pharmacist for specific advice.
Driving Precautions
Enoxaparin is not known to affect the ability to drive or operate machinery. However, if you experience side effects like dizziness, avoid such activities.
Lifestyle Advice
- Avoid activities that carry a high risk of injury or bleeding (e.g., contact sports, vigorous exercise).
- Use a soft toothbrush and an electric razor to minimize bleeding risk.
- Maintain good hygiene to prevent infection at injection sites.
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