Precautions and Warnings With Enoxaparin

You may not be able to use enoxaparin if you have certain medical conditions, such as a bleeding disorder, high blood pressure, or kidney disease. Being aware of these and other enoxaparin precautions and warnings can help ensure a safe treatment process, so make sure your healthcare provider has a list of all medications you are taking and any medical conditions you have.

What Should I Tell My Healthcare Provider?

Talk with your healthcare provider prior to taking enoxaparin (Lovenox®) if you have:
 
  • A bleeding disorder (not a clotting disorder)
  • Intestinal or stomach ulcers or bleeding
  • Bleeding in the brain
  • An aneurysm
  • A bacterial infection of the endocardium (the inner layer of the heart)
  • Had a negative reaction to heparin
  • Kidney disease, such as kidney failure
  • Had recent brain, eye, or spinal surgery
  • High blood pressure
  • Diabetic retinopathy (an eye condition)
  • Any allergies, including allergies to foods, dyes, or preservatives.
     
Also, let your healthcare provider know if you are:
 
  • Breastfeeding
  • Pregnant or thinking of becoming pregnant.
     
Make sure to tell your healthcare provider about any medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.
 

Specific Precautions and Warnings With Enoxaparin

Some warnings and precautions to be aware of prior to taking this medication include the following:
 
  • As with all "blood thinners," one of the most serious side effects of enoxaparin is internal bleeding, which can be fatal. Let your healthcare provider know if you develop any signs of bleeding, such as:
     
    • Easy bruising
    • Cuts or scrapes that are slow to stop bleeding
    • Black, tarry stools, bright-red blood in the stool, or vomiting of blood (signs of gastrointestinal bleeding)
    • Signs of a bleeding in the brain, such as vision or speech changes, weakness or numbness in an arm or leg, or a severe headache.
 
  • There have been reports of spinal or epidural hematoma in people who had spinal, epidural, or caudal anesthesia (or spinal punctures) while on enoxaparin. This is a serious problem that can sometimes cause long-term or permanent paralysis. Each case must be evaluated on an individual basis, but you may not be a candidate for these types of anesthesia or procedures if you are on enoxaparin.
     
  • Make sure your healthcare provider knows if you have kidney disease, diabetic retinopathy, uncontrolled high blood pressure, recent ulcers of the digestive tract, or any obvious bleeding. Extra care must be taken in such situations.
     
  • Enoxaparin should be used with extreme caution in people with bacterial endocarditis, bleeding disorders (that increase the risk of bleeding), active stomach or intestinal ulcers, bleeding in the brain, or who have recently had brain, spinal, or eye surgery.
     
  • Enoxaparin may interact with a number of other medications (see Drug Interactions With Enoxaparin for more information).
     
  • As with other heparin-like drugs, enoxaparin can cause low blood platelets (thrombocytopenia). In many cases, this is mild and causes no other problems. Rarely, though, a severe reaction known as heparin-induced thrombocytopenia (HIT) may occur. This dangerous problem can cause excessive clotting, loss of limbs, and even death.
     
  • Enoxaparin multi-dose vials contain benzyl alcohol, a preservative that can be dangerous to premature newborns. Because benzyl alcohol may cross the placenta, pregnant women should generally avoid using enoxaparin multi-dose vials. This is not a problem with the single-dose syringes.
     
  • It is not known if enoxaparin passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, discuss this with your healthcare provider prior to taking the drug (see Lovenox and Breastfeeding).
     
  • Enoxaparin is considered a pregnancy Category B medication. This means that it is probably safe for use during pregnancy, although the full risks are currently unknown (see Lovenox and Pregnancy).
     
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