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What is this medication?

Anticoagulant, Low Molecular Weight Heparin

LOVENOX and biosimilars INCLUNOX, NOROMBY, and REDESCA are low molecular weight heparins indicated for treatment of acute coronary syndrome, deep vein thrombosis, and venous thromboembolism.

Epidural or spinal hematomas may occur in patients who are anticoagulated with LMWHs or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures.  Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.  Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.

What is a biosimilar biologic drug?

Manufacturers have found cost-efficient ways to recreate the molecules used in the original or “reference” biologic drug.  Biosimilars are highly “similar” to a reference biological drug despite differing in their chemical composition.  

The FDA approval of biosimilar drugs is based on a totality of evidence which is used by regulators in the approval of reference and biological drugs.  The FDA uses the same approach in evaluating biosimilars to confirm that there are no clinically meaningful differences in safety and efficacy between the reference biologic drug and the biosimilar.  The rigorous standard for authorization means that you can have confidence knowing that the quality, safety, and efficacy of a biosimilar is the same as any other biologic drug.

LOVENOX is a biologic
INCLUNOX is a biosimilar to LOVENOX (Enoxaparin)
NOROMBY is a biosimilar to LOVENOX (Enoxaparin)
REDESCA is a biosimilar to LOVENOX (Enoxaparin)

How does this medication work? 

LOVENOX/INCLUNOX/NOROMBY/REDESCA (Enoxaparin) is a low molecular weight heparin that acts as an anticoagulant by increasing the inhibition rate of clotting proteases by antithrombin III impairing normal hemostasis and inhibition of factor Xa.  Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin has a higher ratio of anti-factor Xa to anti-factor IIa activity than unfractionated heparin.

How should I take this medication? 

SQ: Subcutaneous dose injected is dependent upon body mass index and condition used.

How to Use: Administer a deep subcutaneous injection by alternating between the left or right anterolateral and left or right posterolateral abdominal wall. Do not mix with other infusions or injections. In order to minimize bruising, do not rub injection site. To avoid loss of drug from the 30 mg and 40 mg prefilled syringes, do not expel the air bubble from the syringe prior to injection.

What should I watch for while using this medication? 

Before starting LOVENOX/INCLUNOX/NOROMBY/REDESCA (Enoxaparin), make sure your physician is aware of any allergies or medications you currently take.  The anticoagulant activity of Enoxaparin can increase the risk of bleeding which is higher in patients with bacterial endocarditis; congenital or acquired bleeding disorders; active ulcerative or angiodysplastic GI diseases; severe uncontrolled hypertension; hemorrhagic stroke; or use shortly after brain, spinal, or ophthalmic surgery; in patients treated concomitantly with platelet inhibitors; recent GI bleeding or ulceration; renal dysfunction and hemorrhage; thrombocytopenia or platelet defects or history of heparin-induced thrombocytopenia; severe liver disease; hypertensive or diabetic retinopathy; or in patients undergoing invasive procedures.  Enoxaparin has been known to cause thrombocytopenia with cases of HIT and heparin-induced thrombocytopenia with thrombosis (HITTS), some complicated by organ infarction, limb ischemia, or death.

What size needle does this medication use?

Prefilled syringe: 27-gauge, ½ inch needle

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Protect from light. Store in the original carton or packaging until ready to use. Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

Anemia, hemorrhage, peripheral edema, confusion, nausea, major hemorrhage, bleeding and/or pain at the injection site, hematuria, fever.

Note this is not a complete list of side effects for LOVENOX/INCLUNOX/NOROMBY/REDESCA (Enoxaparin), only common ones.

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