Enoxaparin Injection

If you have epidural or spinal anesthesia or a shot in your spine while taking a 'blood thinner' such as enoxaparin, you could get a blood clot near your spine that can cause paralysis. Tell your doctor if you are taking other anticoagulants ('blood thinners') such as warfarin, anagrelide, aspirin or nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen), cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, sulfinpyrazone, ticlopidine, or tirofiban.

If you experience any of the following symptoms, call your doctor immediately: numbness, tingling, leg weakness or paralysis, and trouble controlling your bladder or bowels.

Talk to your doctor about the risk of taking enoxaparin. Keep all appointments with your doctor.

Enoxaparin is used to prevent and treat deep vein thrombosis (DVT; blood clots that form in the veins, typically in the legs). It is also used to prevent complications from angina (chest pain) and heart attacks. Enoxaparin is in a class of medications called low molecular weight heparins. It works by stopping the formation of substances that cause clots.

Enoxaparin comes as a solution (liquid) in a vial or a prefilled syringe to be injected subcutaneously (under the skin). Inject twice a day. Use enoxaparin exactly as directed. Do not inject more or less of it or inject it more often than prescribed by your doctor.

Continue to use enoxaparin even if you feel well. Do not stop taking enoxaparin without talking to your doctor.

Your healthcare provider will teach you how to give yourself the injection or have a caregiver give you the injection. Inject in the stomach area. You must use a different area of the stomach each time you give the shot. If you have questions about where to give the shot, ask your healthcare provider. Each prefilled syringe has enough drug in it for one shot. Do not use the syringe and needle more than one time. Your doctor, pharmacist, or health care provider will tell you how to dispose of used needles and syringes to avoid accidental injury. Keep syringes and needles out of reach of children.

To inject enoxaparin prefilled syringes, follow these instructions:

1. Wash your hands.
2. Look at the syringe to be sure the drug is clear and colorless or pale yellow.
3. Clean the area of skin where you will give the shot with an alcohol wipe.
4. Take the cap off the needle. Do not push any air or drug out of the syringe before giving the shot unless your healthcare provider tells you to.
5. Lie down and pinch a fold of skin between your finger and thumb. Push the entire needle into the skin and then press down on the syringe plunger to inject the drug. Hold onto the skin the entire time you give the shot. Do not rub the site after you give the shot.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking enoxaparin,

• tell your doctor or pharmacist if you are allergic to this medication, any part of this medication, or any other medications, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while receiving enoxaparin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• the following nonprescription products may interact with enoxaparin: aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Be sure to let your doctor and pharmacist know that you are taking these medications before you start receiving enoxaparin. Do not start any of these medications while receiving enoxaparin without discussing with your healthcare provider.
• tell your doctor if you have an artificial heart valve and if you have or have ever had kidney disease, infection in your heart, a stroke, a bleeding problem, ulcers, or a low platelet count.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking enoxaparin, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking enoxaparin.

Inject the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not inject a double dose to make up for a missed one.

Enoxaparin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• fever
• irritation or burning at site of injection

If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• unusual bleeding or bruising
• black or bloody stools
• blood in urine
• swollen ankles and/or feet

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication out of reach of children. Store the syringes at room temperature and away from excess heat and moisture (not in the bathroom). Do not use the syringe if it leaks or if the fluid is dark or contains particles.

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to monitor your enoxaparin therapy.

Enoxaparin prevents blood from clotting, so it may take longer for bleeding to stop if you get cut or hurt. Avoid activities where you can get hurt. Call your doctor if you bleed more than usual.

Do not let anyone else use your medication.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

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