High-Alert Medicines

Lovenox (enoxaparin)

Extra care is needed because enoxaparin is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Enoxaparin

When taking enoxaparin (blood thinner)

Take exactly as directed. Take enoxaparin the same time each day. Do not take extra doses or skip any doses.
Prepare exact dose. Ask your doctor, nurse, or pharmacist to teach you how to measure your dose.You may need to inject the full contents of a prefilled syringe, or discard a portion of the medicine in the syringe before injection. Do not expel the air bubble from the 30 mg and 40 mg syringes before injecting the medicine. It helps push the medicine into the body so it will not leak back out the injection site.
Inject the medicine. Follow the instructions below to inject the medicine into fatty areas of the abdomen, about 2 inches from the belly button. Do not inject the medicine into muscle, as this can cause a painful bruise.
Rotate injection sites. Write down the date, time, and location of the injection site for every dose. Use the opposite side of the abdomen each time you inject your medicine to prevent the skin from hardening.
Don't reuse or recycle. Dispose of used syringes in a sealable hard plastic or metal container (e.g.,empty detergent bottle or a special sharps container from your pharmacy). Keep this container away from children. When the container is full, seal the lid and discard the container according to your community guidelines (www.safeneedledisposal.org). Do not recycle or reuse syringes.
Tell your doctor about new medicines. Avoid starting or stopping other medicines without informing the doctor who prescribed enoxaparin. This includes prescription medicines and nonprescription medicines such as aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve), which can increase your risk of bleeding.
Take precautions. Use an electric razor. Avoid sharp objects and fall risks (climbing a ladder, for example).
Tell your dentist and doctor. Let your physicians and dentists know you are taking enoxaparin before any surgery or procedure is scheduled and before any new medicine is prescribed or taken.
Signs of bleeding or clot. Call your doctor immediately if you experience any signs of bleeding or clot formation, which are listed below.
Injection site redness. Call your doctor if you develop redness, swelling, burning, or pain in the abdomen where you injected the medicine.

To watch a video with step-by-step instructions for injecting enoxaparin (Lovenox), visit here.

Signs of bleeding

Unusual pain, swelling, discomfort (may also be a sign of a clot)
Unusual or easy bruising
Pink or brown urine
Prolonged bleeding of gums or cuts
Persistent, frequent nosebleeds that don't stop within 7 minutes
Unusually heavy/long menstrual flow
Coughing up blood
Vomit that is bloody or looks like coffee grounds
Rash of dark red or purple spots under the skin
Severe dizziness, weakness, confusion, headache, fainting, unusual tiredness
Tingling, numbness, muscle weakness in legs
Bloody or black stools
Pain in joints, back, or chest
Bleeding at the injection site

Signs of a clot

In the lung: chest pain, fast heart rate, coughing, shortness of breath, fever
In the arm or leg: sudden leg, arm, or back pain, swelling, redness and warmth, tenderness
In the brain: headache, vision changes, seizure, slurred speech, weakness on one side of body, dizziness
In the heart: chest pain, shortness of breath, sweating, nausea and vomiting
In the abdomen: abdominal pain, vomiting, diarrhea

Public Health Advisory

Caution with spinal anesthesia

Patients on enoxaparin who undergo spinal or epidural anesthesia or spinal puncture are at risk for bleeding into their spine. This may cause long-term or permanent paralysis. The risk of bleeding is greater in those who take nonsteroidal anti-inflammatory drugs such as Celebrex (celecoxib), Motrin (ibuprofen), and Aleve (naproxen). These patients should tell their doctor they are taking enoxaparin and immediately report any signs of spinal bleeding, especially tingling, numbness, and muscle weakness in the legs.

Topics	Fast Facts
Generic name	enoxaparin (pronounced ee noks a PA rin)
Brand name	Lovenox
Uses	Prevent blood clots after major surgeries (i.e., hip or knee replacement, abdominal surgery) or in very ill patients with limited mobility Treat heart conditions such as angina or after certain heart attacks
Usual dose limits	30 mg to 40 mg every 12 or 24 hours daily for 7 to 10 days for adult patients Doses may vary by condition being treated and by body weight
What to do if you miss a dose	If it is still the same day, take the dose as soon as you remember it If it is the next day, skip the missed dose and take your normal dose Do not double the dose to catch up Contact your doctor if you miss two or more doses in a row
Special instructions and precautions	Take exactly as prescribed, the same time each day Do not make major changes to your diet unless instructed by your doctor You will have a tendency to bleed easily, so use a soft toothbrush, waxed dental floss, electric razor; avoid sharp objects and fall risks (such as climbing a ladder) Do not start or stop any medicine, including nonprescription medicines, herbals, and vitamins, without letting your doctor or pharmacist know
Safety during pregnancy/breastfeeding	Tell your doctor if you are pregnant or become pregnant While breastfeeding, let the infant's doctor know for proper monitoring
Tell your doctor if you have:	Diseases: prosthetic heart valve or kidney impairment Procedures: recently had or are going to have spinal or epidural anesthesia, or spinal injections, for surgery or to manage pain
Storage and disposal	Store at room temperature; do not freeze or refrigerate Dispose of syringes securely in a hard container as noted in safety tip #5 (front page)
Side effects to report to your doctor immediately	Signs of bleeding or clot (see top of page), accidental falls or trauma (even if you feel fine), headache, confusion
Other conditions to report to your doctor	New or stopped medicines (including nonprescription drugs, herbals, and vitamins), changes in smoking or eating habits, infection, fever
Nonprescription medicines/herbals/vitamins that should not be taken with enoxaparin	Aspirin, nonsteroidal anti-inflammatory drugs (ibuprofen [Advil, Motrin], naproxen [Aleve]), most herbals (particularly cat’s claw, dong quai, evening primrose, feverfew, garlic, ginkgo, American ginseng, ginger, green tea, horse chestnut, red clover, alfalfa, anise, bilberry)
Prescription medicines that should not be taken with enoxaparin	Many prescription medicines interact with enoxaparin Tell your doctor about all the medicines you take
Special tests your doctor may prescribe	Your doctor will determine when you will need a blood test done, usually to check your platelets (cells that help blood clot); also, stool and urine may be checked for blood

‍

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

‍