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| {{drugbox
| | #REDIRECT [[Enoxaparin#Pharmacology]] |
| | IUPAC_name = 6-[5-acetylamino-4,6-dihydroxy-2- (sulfooxymethyl)tetrahydropyran-3-yl] oxy-3- [5-(6-carboxy-4,5-dihydroxy-3- sulfooxy-tetrahydropyran-2-yl)oxy-6-(hydroxymethyl)- 3-sulfoamino-4-sulfooxy-tetrahydropyran-2-yl] oxy-4-hydroxy-5-sulfooxy-tetrahydropyran-2- carboxylicacid
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| | image = Enoxaparin_svg.png
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| | width = 300px
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| <!-- Commented out because image was deleted: | image2 = Lovenox2.gif -->
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| | CAS_number = 9005-49-6
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| | ATC_prefix = B01
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| | ATC_suffix = AB05
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| | ATC_supplemental =
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| | PubChem = 772
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| | DrugBank = APRD00068
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| | chemical_formula = (C<sub>26</sub>H<sub>40</sub>N<sub>2</sub>O<sub>36</sub>S<sub>5</sub>)n
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| | molecular_weight = 4500 daltons (average)
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| | bioavailability = 92%
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| | protein_bound = 80% bound-albumin
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| | metabolism = primarily by liver by desulfation and/or depolymerization
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| | elimination_half-life = 4.5 hours
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| | pregnancy_category = B
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| | legal_status =
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| | routes_of_administration = Subcutaneous (SC) Injection and intervenous (IV) per package insert
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| }}
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| ==Overview==
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| '''Enoxaparin''' is a [[low molecular weight heparin]] manufactured by [[Sanofi-Aventis]]. It is marketed as Lovenox or Clexane. Enoxaparin injections are derived from the intestinal mucosa of pigs.
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| Enoxaparin is used to prevent and treat [[deep vein thrombosis]] or [[pulmonary embolism]], and is given as a [[subcutaneous]] injection (by a health care provider or the patient). Its use is evolving in [[acute coronary syndrome]]s (ACS).
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| ==Indications==
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| In the United Kingdom, enoxaparin is approved for five indications:
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| * The prophylaxis of [[thromboembolism]] disorders of venous origin, in particular those which may be associated with [[orthopaedic surgery]].
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| * The prophylaxis of [[venous thrombosis|venous thromboembolism]] (VTE) in medical patients bedridden due to acute [[illness]].
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| * The treatment of venous thromboembolism disease (VTED) presenting with [[deep vein thrombosis]] (DVT), [[pulmonary embolism]] (PE) or both.
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| * The treatment of unstable [[Angina pectoris|angina]] (UA) and non-Q-wave [[myocardial infarction]] (NQMI), administered concurrently with [[aspirin]].
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| * The prevention of thrombus formation in the extracorporeal circulation during [[haemodialysis]].
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|
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| In the United States, enoxaparin is [[FDA]] approved for eight indications:
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| * Prophylaxis of DVT in medically ill patient,
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| * Total hip & knee replacement,
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| * Extended hip-replacement,
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| * Abdominal surgery.
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| * Treatment of DVT with or with out PE inpatient and
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| * Treatment of DVT inpatient, with ACS, including STEMI.
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| ==Mechanism of action==
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| Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa. The anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit [[factor Xa]]. Factor Xa catalyzes the conversion of prothrombin to [[thrombin]], so enoxaparin’s inhibition of this process results in decreased thrombin and ultimately the prevention of [[fibrin]] clot formation.
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| =Monitoring=
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| * Enoxaparin does not affect the INR, PT or aPTT
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| * Anti-factor Xa levels can be measured, and are often used to monitor enoxaparin activity
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| ==Pregnancy==
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| * Category B: enoxaprin is safe for use in the [[second trimester]] as it does not cross the [[placenta]]
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| ==Side effects==
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| * [[Bleeding]]
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| * [[Thrombocytopenia]], i.e. can be associated with [[heparin-induced thrombocytopenia]]
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| * [[Pain and nociception|Pain]], [[bruising]] or [[irritation]]; hard, inflamed [[nodule]]s or an itchy red [[rash]] at the [[Injection (medicine)|injection]] site
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| * Symptoms similar to those of [[hayfever]]
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| * [[Abdomen|Abdominal]]/[[chest]] pain
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| * [[Headache]]
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| ==Reversal Agent==
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| * [[Protamine]], although not as effective at reversal as it is for heparin due to more activity at the Xa clotting factor (enoxaparin); as heparin has both Xa and IIa. Protamine sulfate will reverse enoxaparin by 66% per package insert.
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| ==Availability==
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| 100 mg/mL
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| * Prefilled Syringes: 30mg/0.3mL, 40mg/0.4mL
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| * Graduated Prefilled Syringes: 60mg/0.6mL, 80mg/0.8mL, 100mg/1mL
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| * Multiple Dose Vials: 300mg/3.0mL
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| 150mg/mL
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| *Graduated Prefilled Syringes: 120mg/0.8mL, 150mg/1mL
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| ==External links==
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| *[http://redpoll.pharmacy.ualberta.ca/drugbank/cgi-bin/getCard.cgi?CARD=APRD00068 DrugBank Information]
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| *[http://en.sanofi-aventis.com/group/products/p_group_products_cardio_lovenox.asp Sanofi-Aventis information]
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| *[http://products.sanofi-aventis.us/lovenox/lovenox.html Lovenox: Prescribing Information]
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| {{Antithrombotics}}
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| [[Category:Anticoagulants]]
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| [[Category:Sanofi-Aventis]]
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| [[Category:Drugs]]
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| [[pl:Enoksaparyna]]
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