Enoxaparin

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1. enoxaparin Lakshmi Narayana M

2. Introduction Mechanism of action Pharmacokinetics Indications Recommended dosing schedule Contraindications/ Precautions Possible side effects Areas to cover….

3. Introduction It is an anticoagulant medication (blood thinner). Enoxaparin belongs to the class of drugs known as low molecular weight heparins (LMWH). Enoxaparin was first made in 1981 and approved for medical use in 1993. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. Enoxaparin is made from heparin.

4. Mechanism of action… 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 . Factor Xa catalyses 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. Low molecular weight heparins are less effective at inactivating factor IIa due to their shorter length.

5. Pharmacokinetics Absorption : Mean absolute bioavailability of enoxaparin, after 1.5 mg/kg given subcutaneously is 100 %. Distribution : 80% bound-albumin Metabolism : Undergoes desulfation and polymerization via the liver, half life is 4.5 hr Elimination : Renal clearance of active fragments represents about 10% of the administered dose and total renal excretion of active and non-active fragments 40% of the dose.

6. Indications Treatment of unstable angina (UA) and non-Q-wave myocardial infarction (NQMI), administered concurrently with aspirin DVT prophylaxis in knee replacement surgery DVT prophylaxis in hip replacement surgery DVT prophylaxis in abdominal surgery Treatment of DVT with or without pulmonary embolism Treatment of DVT inpatient, with ST-segment elevation myocardial infarction (STEMI) Note : DVT: Deep vain thrombosis ( formation of blood clots. )

7. Recommended dosing schedule Usual Adult Dose 1 to 1.5 mg/kg sc for every 12 hrs Acute ST segment elevation myocardial infarction: A single 30 mg intravenous bolus plus a 1 mg/kg subcutaneous dose followed by 1 mg/kg subcutaneously every 12 hours Usual Pediatric Dose less than 2 months: 1.5 mg/kg subcutaneously every 12 hours. 2 months to 17 years: 1 mg/kg subcutaneously every 12 hours.

8. Contraindications/Precautions Enoxaparin is contraindicated in patients with active major bleeding, thrombocytopenia, and patients with hypersensitivity to benzyl alcohol and/or pork products. Use with caution in patients with a history of heparin-induced thrombocytopenia and those at an increased risk of bleeding. Therapy should be discontinued in the event of severe haemorrhage Enoxaparin is intended for subcutaneous and intravenous administration. It should not be administered by intramuscular injection.

9. Possible side effects Local reactions: local irritation, pain, hematoma, ecchymosis, erythema Bleeding Hyperkalemia Transaminitis Hemorrhage Box warning in next slide!!!!