Formulary
Enoxaparin sodium: Indications, Dosing, Side Effects and Interactions
Enoxaparin sodium is a low molecular weight heparin that acts as an anticoagulant by enhancing the effect of antithrombin III to primarily inhibit activated...
MedNext Academy | 6 min read
Enoxaparin sodium: Indications, Dosing, Side Effects and Interactions
Enoxaparin sodium is a low molecular weight heparin that acts as an anticoagulant by enhancing the effect of antithrombin III to primarily inhibit activated...
Drug action
Enoxaparin sodium is a low molecular weight heparin that acts as an anticoagulant by enhancing the effect of antithrombin III to primarily inhibit activated factor X (factor Xa), with a lesser effect on thrombin.
Indications and dose
**Treatment of venous thromboembolism in pregnancy**
- **Adult** (By Subcutaneous Injection): (body-weight 90 kg and above) 100 mg twice daily, dose based on early pregnancy body-weight.
**Prophylaxis of deep-vein thrombosis, especially in surgical patients-moderate risk**
- **Adult** (By Subcutaneous Injection): 20 mg for 1 dose, dose to be given approximately 2 hours before surgery, then 20 mg every 24 hours.
**Prophylaxis of deep-vein thrombosis, especially surgical patients-high risk (e.g. orthopaedic surgery)**
- **Adult** (By Subcutaneous Injection): 40 mg for 1 dose, dose to be given 12 hours before surgery, then 40 mg every 24 hours.
**Prophylaxis of deep-vein thrombosis in medical patients**
- **Adult** (By Subcutaneous Injection): 40 mg every 24 hours.
**Treatment of deep-vein thrombosis in uncomplicated patients with low risk of recurrence,Treatment of pulmonary embolism in uncomplicated patients with low risk of recurrence**
- **Adult** (By Subcutaneous Injection): 1.5 mg/kg every 24 hours until adequate oral anticoagulation established.
**Treatment of deep-vein thrombosis in patients with risk factors such as obesity, cancer, recurrent VTE, or proximal thrombosis,Treatment of pulmonary embolism in patients with risk factors such as obesity, symptomatic pulmonary embolism, cancer, or recurrent VTE**
- **Adult** (By Subcutaneous Injection): 1 mg/kg every 12 hours until adequate oral anticoagulation established.
**Treatment of acute ST-segment elevation myocardial infarction (patients not undergoing percutaneous coronary intervention)**
- **Adult** (By Subcutaneous Injection): Initially by intravenous injection 18-74 years Initially 30 mg for 1 dose, followed immediately by (by subcutaneous injection) 1 mg/kg for 1 dose (max. per dose 100 mg), then (by subcutaneous injection) 1 mg/kg for 1 dose (max. per dose 100 mg), to be administered 12 hours after initial subcutaneous dose, then (by subcutaneous injection) 1 mg/kg every 12 hours, total treatment for up to 8 days or until hospital discharge, whichever is sooner. 75 years and over 750 micrograms/kg every 12 hours (max. per dose 75 mg) for 2 doses, then 750 micrograms/kg every 12 hours, total treatment for up to 8 days or until hospital discharge, whichever is sooner.
**Unstable angina,Non-ST-segment-elevation myocardial infarction**
- **Adult** (By Subcutaneous Injection): 1 mg/kg every 12 hours usually for 2-8 days (minimum 2 days).
**Treatment of thrombotic episodes for enoxaparin sodium**
- **Neonate** (By subcutaneous injection): 1.5-2 mg/kg twice daily.
- **Child 1 month** (By subcutaneous injection): 1.5 mg/kg twice daily.
- **Child 2 months-17 years** (By subcutaneous injection): 1 mg/kg twice daily.
**Treatment of venous thromboembolism in pregnancy for enoxaparin sodium**
- **Child 12-17 years (body-weight up to 50 kg)** (By subcutaneous injection): 40 mg twice daily, dose based on early pregnancy body-weight.
- **Child 12-17 years (body-weight 50-69 kg)** (By subcutaneous injection): 60 mg twice daily, dose based on early pregnancy body-weight.
- **Child 12-17 years (body-weight 70-89 kg)** (By subcutaneous injection): 80 mg twice daily, dose based on early pregnancy body-weight.
- **Child 12-17 years (body-weight 90 kg and above)** (By subcutaneous injection): 100 mg twice daily, dose based on early pregnancy body-weight.
**Prophylaxis of thrombotic episodes for enoxaparin sodium**
- **Neonate** (By subcutaneous injection): 750 micrograms/kg twice daily.
- **Child 1 month** (By subcutaneous injection): 750 micrograms/kg twice daily.
- **Child 2 months-17 years** (By subcutaneous injection): 500 micrograms/kg twice daily (max. per dose 20 mg).
Cautions
Elderly; risk of bleeding; severe hypertension Cautions For enoxaparin sodium Low body-weight (increased risk of bleeding); Obesity (increased risk of thromboembolism)
Contraindications
Acute bacterial endocarditis; after major trauma; avoid injections containing benzyl alcohol in neonates; epidural anaesthesia with treatment doses; haemophilia or other haemorrhagic disorders; peptic ulcer; recent cerebral haemorrhage; recent surgery to eye; recent surgery to nervous system; spinal anaesthesia with treatment doses; thrombocytopenia (including history of heparin-induced thrombocytopenia) Contra-indications For enoxaparin sodium Mechanical prosthetic heart valve
Side effects
Common or very common Haemorrhage; heparin-induced thrombocytopenia; skin reactions Rare or very rare Alopecia; hyperkalaemia; osteoporosis (following long term use); spinal haematoma Side-effects, further information Haemorrhage If haemorrhage occurs it is usually sufficient to withdraw heparin or a low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulfate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Heparin-induced thrombocytopenia Clinically important heparin-induced thrombocytopenia is immune-mediated and can be complicated by thrombosis. Signs of heparin-induced thrombocytopenia include a 30% reduction of platelet count, thrombosis, or skin allergy. If heparin-induced thrombocytopenia is strongly suspected or confirmed, the heparin should be stopped and an alternative anticoagulant, such as danaparoid, should be given. Ensure platelet counts return to normal range in those who require warfarin. Hyperkalaemia Inhibition of aldosterone secretion by heparin or a low molecular weight heparin can result in hyperkalaemia; patients with diabetes mellitus, chronic renal failure, acidosis, raised plasma potassium or those taking potassium-sparing drugs seem to be more susceptible. The risk appears to increase with duration of therapy. Side-effects For enoxaparin sodium Common or very common Haemorrhagic anaemia; headache; hypersensitivity; thrombocytopenia; thrombocytosis Uncommon Hepatic disorders; injection site necrosis; intracranial haemorrhage Rare or very rare Cutaneous vasculitis; eosinophilia Frequency not known Acute generalised exanthematous pustulosis (AGEP)
Interactions
**Other interactions (2):**
- These agents include medicinal products such as: - Systemic salicylates, acetylsalicylic acid at anti-inflammatory doses, and NSAIDs including ketorolac, - Other thrombolytics (e.g.
- Concomitant use with caution: The following medicinal products may be administered with caution concomitantly with enoxaparin sodium: Other medicinal products affecting haemostasis such as: -...
Pregnancy
Treatment of venous thromboembolism in pregnancy for enoxaparin sodium By subcutaneous injection Adult (body-weight up to 50 kg) 40 mg twice daily, dose based on early pregnancy body-weight. Adult (body-weight 50-69 kg) 60 mg twice daily, dose based on early pregnancy body-weight. Adult (body-weight 70-89 kg) 80 mg twice daily, dose based on early pregnancy body-weight. Adult (body-weight 90 kg and above) 100 mg twice daily, dose based on early pregnancy body-weight.
Breast feeding
Manufacturer advises suitable for use during breast feeding-passage into breast milk and absorption by the nursing infant considered to be negligible due to the relatively high molecular weight of enoxaparin and inactivation in the gastro-intestinal tract.
Hepatic impairment
Manufacturer advises caution-no information available.
Renal impairment
Risk of bleeding increased; use of heparin may be preferable. Manufacturer advises avoid if creatinine clearance less than 15 mL/minute. Dose adjustments Manufacturer advises reduce dose if creatinine clearance 15-30 mL/minute-consult product literature for details.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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