Lovenox dosage, forms, and strengths

Lovenox (generic: enoxaparin) is a brand-name prescription anticoagulant used to prevent and treat blood clots. When a blood clot forms in the circulatory system, it can travel through the bloodstream, block up a blood vessel, and reduce or stop blood flow to vital organs such as the heart or brain. Enoxaparin sodium, the active ingredient in Lovenox, blocks one step in the blood clotting process to prevent blood clots from forming or, in treating an existing blood clot, help speed the body’s process of dissolving the blood clot. Lovenox is administered as an injection. For many conditions, the injection will be administered by a healthcare provider, but the Lovenox injections can also be administered at home using single-dose prefilled syringes.

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Lovenox forms and strengths

For Lovenox, injections are the only dosage form available. 

• Prefilled syringe: 30 milligrams (mg) per 0.3 milliliters (mL), 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/mL, 120 mg/0.8 mL, 150 mg/mL

• Injection: 100 mg/mL

Lovenox dosage for adults

Lovenox is used to prevent or treat blood clots across a spectrum of heart and vascular conditions including venous thromboembolism (deep vein thrombosis or pulmonary embolism), prevention of complications of unstable angina (a condition in which the heart doesn't get enough blood flow and oxygen), and treatment of other heart problems. It is also a mainstay in preventing blood clots in people undergoing hip replacement surgery, knee replacement surgery, abdominal surgery, or who are bedridden in a hospital, all of which carry an increased risk of blood clots forming in the deep veins of the leg. In addition, a healthcare professional may use enoxaparin off-label to prevent blood clots for other conditions including other types of surgery, trauma, spinal cord injury, pregnancy-related conditions, congestive heart failure, and other situations that increase the risk of blood clotting. Shots are usually administered under the skin, called a subcutaneous injection, but for certain conditions, a healthcare provider may inject the medicine directly into the bloodstream (intravenous injection).

Source: DailyMed

Lovenox dosage for venous thromboembolism

Venous thromboembolism (VTE) is a serious medical condition in which a blood clot blocks blood flow in a large vein either in a leg, hip, or arm (deep vein thrombosis or DVT) or a blood vessel in the lungs (pulmonary embolism or PE). Enoxaparin, the active ingredient in Lovenox, is a low molecular weight heparin (LMWH), a type of anticoagulant that helps the body break up blood clots by blocking one step in the blood clotting process. 

Blood clots form when platelets, a type of blood cell, “glue” themselves together into a mass. This “gluing” process follows a specific sequence of chemical steps. Factor Xa is the crucial step where the blood clotting process moves from the inside of platelets to the outside, where the gluing takes place. Both unfractionated heparin and low molecular weight heparins such as enoxaparin, called factor Xa inhibitors, shut down this critical step.

People being treated with Lovenox for venous thromboembolism will also take the blood thinner warfarin, usually starting within 72 hours of the first dose of Lovenox. 

• Standard dosage for inpatient treatment of VTE: 1 mg/kg subcutaneous injection every 12 hours for at least five days or 1.5 mg/kg every day for at least five days

• Standard dosage for outpatient treatment of VTE: 1 mg/kg subcutaneous injection every 12 hours for at least five days

Lovenox dosage for the prophylaxis of deep vein thrombosis

Lovenox is also used to reduce the incidence of deep vein thrombosis (DVT) in people at risk for blood clots due to surgical procedures or hospitalization. A deep vein clot has the potential to migrate to blood vessels in the lungs, causing a potentially life-threatening condition called pulmonary embolism (PE). The U.S. Food and Drug Administration (FDA) has approved Lovenox for use in people having total hip replacement surgery, knee replacement surgery, abdominal surgery, or who are hospitalized with an acute illness and unable to move around. 

In addition to approved procedures, healthcare providers may use Lovenox off-label to prevent venous thrombosis for a variety of other medical procedures including general surgery, gynecologic surgery, laparoscopic surgery, hip fracture surgery, urologic procedures, spinal surgery, vascular surgery, prosthetic heart valve surgery, or widening of the coronary arteries (percutaneous coronary intervention or PCI).

• Standard dosage to prevent DVT after hip replacement surgery: 30 mg subcutaneous injection every 12 hours for seven to 10 days or 40 mg subcutaneous injection once per day for up to three weeks

• Standard dosage to prevent DVT after knee replacement surgery: 30 mg subcutaneous injection every 12 hours for seven to 10 days or 40 mg subcutaneous injection once per day for up to three weeks

• Standard dosage to prevent DVT after abdominal surgery: 40 mg subcutaneous injection once per day for seven to 10 days

• Standard dosage to prevent thromboembolic (blood clot) complications due to mobility-restricted hospitalization for acute illness: 40 mg subcutaneous injection once per day for six to 11 days

Lovenox dosage for acute coronary syndrome

Lovenox is also used to reduce the risk of thromboembolic (blood clot) complications in people with certain types of acute coronary syndrome, or ACS. Acute coronary syndrome describes any heart condition in which blood flow to the heart is reduced because of plaque or blood clots. Most ACS events involve chest pain and other symptoms which do not cause the death of heart tissues. The most serious ACS events, however, are heart attacks (myocardial infarction) in which heart muscle tissues die for lack of oxygen.

Lovenox is used in ACS when there is a high risk of blood clot complications and heart attack. These include the acute treatment of unstable angina (chest pain) as well as a type of heart attack in which there is no electrocardiogram (ECG) evidence of tissue death called a non-q-wave myocardial infarction or NQWMI. Lovenox is also used for the acute treatment of the more “classic” heart attack in which there is ECG evidence of heart tissue death, a condition called an ST-segment elevation myocardial infarction or STEMI.

• Standard dosage for unstable angina: 1 mg/kg subcutaneous injection every 12 hours with aspirin for at least two days

• Standard dosage for non-q-wave myocardial infarction: 1 mg/kg subcutaneous injection every 12 hours with aspirin for at least two days

• Standard dosage for ST-segment elevation myocardial infarction: Initial 30 mg IV bolus followed by a 1 mg/kg subcutaneous injection every 12 hours with aspirin

Lovenox dosage for children

The FDA has not approved the pediatric use of Lovenox. Some healthcare providers, however, may administer Lovenox to either prevent or treat blood clots in children.

Lovenox dosage restrictions

Lovenox dose adjustments may be needed for a variety of reasons including age, body mass index (BMI), and kidney problems (renal impairment). For patients with excess body weight (high BMI), doses for thromboprophylaxis (surgery or hospitalization) will need to be increased by 30%. Patients older than 75 will need reduced doses when Lovenox is used for unstable angina or heart attack. All people with severe renal impairment (creatinine clearance (CrCL) <30) will require dose reductions in the form of single daily doses of Lovenox rather than twice-daily doses.

Lovenox contraindications include any person allergic to enoxaparin, pork products, heparin, or benzyl alcohol. People who have experienced low platelet counts when taking heparins (heparin-induced thrombocytopenia) will also not be given Lovenox.

Some people have a higher risk of bleeding when taking Lovenox and require special monitoring. These include people with major bleeding disorders such as a stomach ulcer, hemorrhagic stroke (a stroke caused by a hemorrhage or ruptured blood vessel), high blood pressure, people taking non-steroidal anti-inflammatories (NSAIDs) such as aspirin or ibuprofen, or people who have had recent surgery, spinal tap, epidural anesthesia, or spinal catheter installed or removed.

Lovenox dosage for pets

Enoxaparin is used in dogs and cats to prevent deep vein thrombosis and pulmonary embolism. As with humans, enoxaparin is injected beneath the animal’s skin (subcutaneously). However, the medicine is effective for a shorter time in cats and dogs than people, so doses of enoxaparin are typically given every six hours rather than every 12 hours. While there is no standard dosing for cats and dogs, a dog might receive 0.8 mg/kg every six hours and a cat will get 1 mg/kg every six hours. Always consult with your veterinarian before giving Lovenox to a pet.

How to take Lovenox

Lovenox injections are normally given by a healthcare professional. For some indications, however, patients or their caregivers may administer injections at home using single-dose prefilled syringes.

• Follow the instructions given by the healthcare provider regarding the dose and dosing schedule.

• A healthcare provider will demonstrate how to give a self-injection at home and where on the body to make the injection. Make sure to use a different side of the body and a different location on the body with each injection.

• Prepare the injection site by washing it, drying it, and then rubbing it with an alcohol wipe. Wait for the skin to dry before starting the injection.

• To remove the syringe, peel back the blister package at the arrow.

• Grasp the needle by the barrel to remove it from the blister pack. Do not pull on it with the plunger end.

• Pull the needle guard straight off the needle to remove it.

• Pinch the skin together at the injection site.

• Insert the entire needle into the skin fold.

• With constant pressure, slowly push the plunger to the bottom of the syringe. Do not push hard, especially when the plunger is fully depressed.

• Holding the barrel, remove the needle from the skin. Do not use the plunger to remove the needle.

• Once the needle is removed, push firmly on the plunger to activate the needle guard. The needle will click when the needle guard covers the needle. Do not replace the needle shield.

• Dispose of the used syringe in a sharps container.

• Do not rub the injection site. If there is blood, gently press a cotton ball or gauze to the injection site. 

Lovenox dosage FAQs

How long does it take Lovenox to work?

Lovenox begins to work almost immediately after injection and reaches its maximum effect at preventing blood clots in three to five hours. 

What happens if I miss a dose of Lovenox?

ost medical patients will receive Lovenox injections from a healthcare provider. However, when Lovenox is taken at home, a missed dose should be administered as soon as it’s remembered unless it’s almost time for the next dose. In that case, skip the missed dose and take the next dose as scheduled.

What is the maximum dosage for Lovenox?

Healthcare providers follow very rigid and well-defined guidelines when prescribing Lovenox, so maximum treatment or prophylactic doses will depend on lab tests for anti-factor Xa levels (which show how well the dose is working) as well as clinical assessments. The International Normalization Ratio (INR), the standard test for blood clotting, is not affected by enoxaparin, so it isn’t used to determine Lovenox doses. 

Can you overdose on Lovenox?

Because most people are given Lovenox injections by a healthcare professional, an overdose is unlikely. An accidental overdose, however, may be possible at home and can lead to severe and potentially life-threatening bleeding. There is a drug that can reverse the effects of Lovenox, so if an accidental overdose is suspected, go to an emergency room for immediate medical treatment.

Is it safe to take Lovenox during pregnancy?

Lovenox is normally used in pregnant women when needed. Clinical trials and studies have shown that enoxaparin does not raise the risk of fetal harm or birth defects. However, the preservative used in multi-dose vials of Lovenox, benzyl alcohol, may cause problems to the mother or newborn. 

Women who are breastfeeding are also prescribed enoxaparin with some caution. Limited studies have shown no adverse reactions in a nursing infant or any effects on the infant’s development. Healthcare professionals believe it is unlikely to be present in breast milk and, if so, will be broken down by the infant’s digestive system.

Related resources for Lovenox dosages:

• Enoxaparin, Drugs and Lactation Database

• Enoxaparin drug summary, Epocrates

• Lovenox, Epocrates

• Lovenox prescribing information, U.S. National Library of Medicine

• Plumb’s Veterinary Drug Handbook, 7th Edition