Enoxaparin has predictable absorption, bioavailability, and distribution therefore monitoring is not typically done. However, there are instances where monitoring may be beneficial for special populations, for example individuals with kidney insufficiency or those that are obese. In this case, anti-Xa units can be measured and dosing adjusted accordingly.[9]
Protamine sulfate is less effective at reversing enoxaparin compared to heparin, with a maximum neutralization of approximately 60% of the anti-factor Xa effect.[9]
Enoxaparin is a FDA pregnancy category B drug which means enoxaparin is not expected to cause harm to an unborn baby when used during pregnancy.[9]
Enoxaparin does not cross the placenta therefore it is unlikely an unborn baby would be exposed to it.[9]
Some fetal deaths have been reported by women who used enoxaparin during pregnancy, but it is unclear if enoxaparin caused these deaths.[9]
The multiple-dose vials of the brand name enoxaparin (Lovenox) contain 15 mgbenzyl alcohol per 1 mL as a preservative. Premature infants who have been given large amounts of benzyl alcohol (99–405 mg/kg/day) have experienced "gasping syndrome".[9][15]
Although enoxaparin is used to prevent blood clots, pregnancy alone can raise a woman's risk of clotting.[9]
The FDA issued a revision to the boxed warning for enoxaparin in October 2013.[17] The revision recommends exercising caution regarding when spinal catheters are placed and removed in persons taking enoxaparin for spinal puncture or neuroaxial anesthesia.[18] It may be necessary to delay anticoagulant dosing in these persons in order to decrease the risk for spinal or epidural hematomas, which can manifest as permanent or long-term paralysis.[18] Persons at risk for hematomas may present with indwelling epidural catheters, concurrent use of medications that worsen bleeding states such as non-steroidal anti-inflammatory drugs (NSAIDs), or a past medical history of epidural or spinal punctures, spinal injury, or spinal deformations.[17] The FDA recommends that at-risk persons be monitored for bleeding and neurological changes.[17][19]
Enoxaparin binds to and potentiates antithrombin (a circulating anticoagulant) to form a complex that irreversibly inactivates clottingfactor Xa.[20] It has less activity against factor IIa (thrombin) compared to unfractionated heparin (UFH) due to its low molecular weight.[21]
Distribution: Volume of distribution (anti-Factor Xa activity) = 4.3 liters[17]
Metabolism: Enoxaparin is metabolized in the liver into low molecular weight species by either or both desulfation and depolymerization.[17]
Elimination: A single dose of a subcutaneous injection of enoxaparin has an elimination half-life of 4.5 hours.[17] Approximately 10–40% of the active and inactive fragments from a single dose are excreted by the kidneys.[17] Dose adjustments based on kidney function are necessary in persons with reduced kidney function.[17]
Enoxaparin belongs to the class of drugs known as low molecular weight heparins. Other drugs in this class include dalteparin, fondaparinux and tinzaparin.[22]
In September 2016, Inhixa and Thorinane were approved for use in the European Union.[10][23] Thorinane was withdrawn from the market in October 2019.[24]
In March 2017, Enoxaparin BECAT, Laboratorios ROVI (Spain) obtained marketing authorization in twenty six countries in Europe. The product is now available in Europe.[25]
In October 2020, Noromby and Noromby HP, were approved for medical use in Canada.[26]
In November 2020, Inclunox and Inclunox HP were approved for medical use in Canada.[27]
In December 2020, Redesca and Redesca HP were approved for medical use in Canada.[28]
^ abcdefghij"Enoxaparin Sodium". The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016.
^ abNorthern Neonatal Network (2008). "Enoxaparin". Neonatal Formulary: Drug Use in Pregnancy and the First Year of Life. John Wiley & Sons. p. 96. ISBN9780470750353. Archived from the original on 20 December 2016.
^World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^Gershanik J, Boecler B, Ensley H, McCloskey S, George W (November 1982). "The gasping syndrome and benzyl alcohol poisoning". The New England Journal of Medicine. 307 (22): 1384–1388. doi:10.1056/NEJM198211253072206. PMID7133084.
^Alldredge BK, Corelli RL, Ernst ME, Guglielmo BJ, Jacobson PA, Kradjan WA, Williams BR (February 2012). Koda-Kimble and Young's Applied Therapeutics: The Clinical Use of Drugs (Tenth ed.). Lippincott Williams & Wilkins. pp. 347–348. ISBN978-1-60913-713-7.
N
Y (what is this?) (verify)
