Drug reference

Enoxaparin

Anticoagulant

Also known as Enoxaparin sodium, Lovenox, Clexane

START

1 mg/kg SC q12h (VTE treatment) or 40 mg SC once daily (prophylaxis)

TYPICAL MAX

1.5 mg/kg SC q24h or 1 mg/kg SC q12h treatment

STOP IF

Active bleed · HIT history · severe renal failure (eGFR <15)

WATCH

Anti-Xa (if obese / pregnant / CKD) · platelets · bleeding · spinal hematoma if neuraxial anesthesia

CDSCO approvedSchedule HJan AushadhiATC B01AB05

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 2h · SC absorption
PEAK: 3.5h · Cmax (anti-Xa)
t½: 4.5h · elimination t½
DURATION: 12h · BID dosing window

EXCRETION

70% renal · partially desulfated hepatically

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Category B — does not cross placenta, first-line anticoagulant in pregnancy

FDA category + note

Top interactionssee all 12 →

AbciximabSevereDatabaseDDInter
AcalabrutinibSevereDatabaseDDInter
AlteplaseSevereDatabaseDDInter
AnagrelideSevereDatabaseDDInter

Available in India

197 branded formulations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Enoxaparin selectively binds to antithrombin (AT) and catalyzes its inactivation of Factor Xa. It has a much lower affinity for Factor IIa (thrombin) compared to unfractionated heparin, resulting in a higher anti-Factor Xa to anti-Factor IIa activity ratio. This targeted inhibition of Factor Xa prevents the formation of fibrin clots and inhibits existing clot propagation.

Indications

Prophylaxis of deep vein thrombosis (DVT) in surgical patients (e.g., orthopedic, abdominal)Prophylaxis of DVT in medical patients with acute illness and restricted mobilityTreatment of DVT with or without pulmonary embolism (PE)Treatment of unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI)Treatment of ST-segment elevation myocardial infarction (STEMI) managed medically or with subsequent percutaneous coronary intervention (PCI)Prophylaxis of thrombus formation in extracorporeal circulation during hemodialysisThromboprophylaxis (weight-based prophylactic dosing for obese patients is preferable to fixed dosing)prophylaxis against venous thromboembolismProphylaxis of deep vein thrombosisProphylaxis of pulmonary embolism (in high-risk patients undergoing surgery; stroke or other immobilized patients)Treatment of established deep vein thrombosisUnstable anginaMyocardial infarctionMaintain patency of cannulae and shunts in dialysis patientsAnticoagulant therapy added to antiplatelet agents for NSTE-ACS, especially in patients managed by a conservative strategyAnticoagulation in STEMI patients receiving fibrinolysisVTEprophylaxis for VTE

Dosing

Adult: DVT prophylaxis (moderate risk): 40 mg SC once daily. DVT prophylaxis (high risk): 30 mg SC twice daily or 40 mg SC once daily. DVT/PE treatment: 1 mg/kg SC every 12 hours OR 1.5 mg/kg SC once daily. Unstable angina/NSTEMI: 1 mg/kg SC every 12 hours. STEMI: 30 mg IV bolus plus 1 mg/kg SC, then 1 mg/kg SC every 12 hours (first two SC doses max 100 mg each).…
Pediatric: Not routinely recommended, use off-label under expert guidance for VTE prophylaxis/treatment: infants 0.5 mg/kg SC every 12 hours, children/adolescents 1 mg/kg SC every 12 hours. Dosing must be individualized based on anti-Xa levels.
Renal adjustment: For CrCl < 30 mL/min (severe renal impairment): Prophylaxis: 30 mg SC once daily. Treatment: 1 mg/kg SC once daily. Not recommended for CrCl < 15 mL/min; consider unfractionated heparin.
Hepatic adjustment: No specific dose adjustment recommended for hepatic impairment, but caution is advised in patients with severe hepatic impairment due to increased bleeding risk. Monitor anti-Xa levels.
Geriatric: No specific dose adjustment based solely on age, but greater care with monitoring is needed due to age-related decline in renal function. Renal dose adjustment applies.
Max dose: For STEMI treatment, the first two SC doses are capped at 100 mg each when using 1 mg/kg dosing. No general maximum daily dose for other indications beyond weight-based limits.

Pharmacokinetics

Onset

SC: 3-5 hours (anti-Xa activity). IV: immediate.

Peak effect

SC: 3-5 hours.

Duration

12-24 hours depending on dose and renal function.

Half-life

Terminal half-life: Approximately 4-5 hours after a single SC dose, up to 7 hours after multiple doses. Prolonged in renal impairment.

Bioavailability

Subcutaneous (SC): Approximately 100%.

Protein binding

Low plasma protein binding.

Metabolism

Partially desulfated and/or depolymerized in the liver and kidney.

Excretion

Primarily renal (approximately 40% of anti-Xa activity excreted unchanged in urine).

Contraindications

Active major bleeding or conditions with a high risk of uncontrolled hemorrhage (e.g., hemorrhagic stroke, recent brain/spinal/ocular surgery)
History of heparin-induced thrombocytopenia (HIT) with or without thrombosis
Hypersensitivity to enoxaparin, heparin, or pork products
Spinal or epidural anesthesia/puncture (due to increased risk of spinal/epidural hematoma)
Severe uncontrolled hypertension
Bacterial endocarditis

Side effects

Common

Bleeding (injection site hematoma, ecchymosis)Pain at injection siteNauseaDiarrheaFeverAnemiaThrombocytopenia (non-immune)Elevation of liver enzymes (transaminases)Bleeding (somewhat less incidence than unfractionated heparin)Little effect on plateletsReversible abnormalities of hepatic function tests

Serious

Major hemorrhage (e.g., gastrointestinal, retroperitoneal, intracranial)
Heparin-induced thrombocytopenia (HIT) with or without thrombosis (potentially fatal)
Spinal or epidural hematoma (risk of permanent neurological injury or paralysis)
Hypersensitivity reactions (anaphylaxis)
Hyperkalemia
Osteoporosis (with long-term use)
Thrombocytopenia (<1% incidence)
Osteoporosis (lower risk than unfractionated heparin)
Haemorrhage (major bleeding may be less frequent than UFH)
Thrombocytopenia (less frequent than UFH)
Modest increase in bleeding compared to UFH
Serious bleeding (compared to UFH)