LOVENOX® achieves and maintains therapeutic anti-Xa and IIa levels with maximum
peak activity within 3 to 5 hours. And it provides consistent and predictable anticoagulation.
The mechanism of action of LOVENOX® provides a high anti-Xa:anti-IIa
ratio, potentially increasing antithrombotic effect,
6,10,25-28
100% bioavailability based on factor Xa activity,
10,28
and a lower incidence of heparin-induced thrombocytopenia.
27,28
LOVENOX®—pharmacodynamics
In humans, LOVENOX® given at a dose of 1.5 mg/kg subcutaneously (SC) is characterized
by a higher ratio of anti-factor Xa to anti-factor IIa activity (mean ± SD, 14.0
± 3.1; based on areas under anti-factor activity versus time curves) compared to
the ratios observed for heparin (mean ± SD, 1.22 ± 0.13). Increases of up to 1.8 times
the control values were seen in the thrombin time and the activated partial
thromboplastin time (aPTT).
6
LOVENOX® at a 1 mg/kg dose (100 mg/mL concentration), administered SC every
12 hours to patients in a large clinical trial, resulted in aPTT values of 45 seconds
or less in the majority of patients (n=1607). A 30-mg IV bolus immediately followed
by a 1 mg/kg SC administration resulted in aPTT postinjection values of 50 seconds.
The average aPTT postinjection value on day 1 was about 16% higher than on day 4.
6
Pharmacokinetics of LOVENOX® IV bolus and SC dosing
10,29
In the Le Liboux study
10,29,a
- After an initial 30-mg IV bolus followed by the
first 1-mg/kg q12h SC dose
- —LOVENOX® immediately reached therapeutic anti-Xa
levels (0.66 ± 0.23 IU/mL) and maintained a therapeutic level until the SC dose
was absorbed
- —LOVENOX® provided initial peak anti-Xa levels
of 1.16 ± 0.17 IU/mL 2 to 4 hours after treatment initiation, with an average exposure
corresponding to 84% of steady-state levels
In the PEPCI study
30,b
- LOVENOX® SC provided anti-Xa levels that were within
the target range (0.6 to 1.8 IU/mL) in 98% of patients 2 to 8 hours after the last
SC dose
- An additional 0.3-mg/kg IV bolus given 8 to 12 hours
after the last SC dose maintains anti-Xa levels within target range for an additional
2 hours
Important Safety Information for LOVENOX®
WARNING: SPINAL/EPIDURAL HEMATOMA
Epidural or spinal hematomas may occur in patients who are anticoagulated with low
molecular weight heparins (LMWH) 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.
Factors that can increase the risk of developing epidural or spinal hematomas in
these patients include:
- Use of indwelling epidural catheters
- Concomitant use of other drugs that affect hemostasis, such as non-steroidal
anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants
- A history of traumatic or repeated epidural or spinal punctures
- A history of spinal deformity or spinal surgery
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.
CONTRAINDICATIONS
- LOVENOX® (enoxaparin sodium injection) is contraindicated in patients
with active major bleeding; thrombocytopenia with a positive in vitro test
for anti-platelet antibody in the presence of enoxaparin sodium; known hypersensitivity
to enoxaparin sodium, heparin, pork products, or benzyl alcohol (multi-dose formulation
only)
WARNINGS AND PRECAUTIONS
- LOVENOX® should be used with extreme caution in conditions with increased
risk of hemorrhage. Major hemorrhages including retroperitoneal and intracranial
bleeding have been reported. Some of these cases have been fatal. Bleeding can occur
at any site during LOVENOX® therapy.
An unexplained
fall in hematocrit (HCT) or blood pressure should lead to a search for a bleeding
site
- For percutaneous coronary revascularization procedures, obtain hemostasis
at the puncture site before sheath removal and observe the site for signs of bleeding
or hematoma formation
- In the STEMI population, the rates of major hemorrhages (defined as requiring
5 or more units of blood for transfusion, or 15% drop in HCT or clinically overt
bleeding, including intracranial hemorrhage [ICH]) at 30 days were 2.1% in the LOVENOX®
group and 1.4% in the unfractionated heparin (UFH) group. The rates of ICH at 30
days were 0.8% in the LOVENOX® group and 0.7% in the UFH group. The 30-day rate
of the composite endpoint of death, myocardial infarction, or ICH (a measure of
net clinical benefit) was significantly lower in the LOVENOX® group (10.1%)
compared to the UFH group (12.2%)
- LOVENOX® should be used with caution in patients with bleeding diathesis,
uncontrolled arterial hypertension or a history of recent gastrointestinal ulceration,
diabetic retinopathy, renal dysfunction, or hemorrhage
- Thrombocytopenia can occur with LOVENOX®. In patients with a history of
heparin-induced thrombocytopenia (HIT), LOVENOX® should be used with extreme
caution. Thrombocytopenia of any degree should be monitored closely. If the platelet
count falls below 100,000/mm3, LOVENOX® should be discontinued. Cases
of HIT have been observed in clinical practice
- LOVENOX® cannot be used interchangeably with other branded LMWH or UFH,
as they differ in their manufacturing process, molecular weight distribution, anti-Xa
and anti-IIa activities, units, and dosages
- Pregnant women with mechanical prosthetic heart valves and their fetuses may
be at increased risk for thromboembolism. Frequent monitoring of anti-Factor Xa
levels and adjusting of dosage may be needed
- LOVENOX® multiple-dose vials contain benzyl alcohol and should be used
with caution in pregnant women and only if clearly needed due to the risk of fatal
"gasping syndrome" in premature neonates
- Periodic complete blood counts, including platelet count, and stool occult
blood tests are recommended during the course of treatment with LOVENOX®
ADVERSE REACTIONS
- Most common adverse reactions (>1%) were bleeding, anemia, thrombocytopenia,
elevation of serum aminotransferase, diarrhea, and nausea
For more information, contact your local sanofi-aventis U.S. Representative or call
sanofi-aventis U.S. Medical Information Services
at 1-800-633-1610.
Please see full Prescribing Information, including boxed WARNING.
Prescription LOVENOX® is available in pharmacies.
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