From the FDA Drug Label
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL NDC 11797-757-06 Enoxaparin Sodium Injection USP 30 mg/0.3 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0.3 mL Syringes NDC 11797-758-06 Enoxaparin Sodium Injection USP 40 mg/0.4 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 4 mL Syringes NDC 11797-759-06 Enoxaparin Sodium Injection USP 60 mg/0.6 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0.6 mL Syringes NDC 11797-760-06 Enoxaparin Sodium Injection USP 80 mg/0.8 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 8 mL Syringes NDC 11797-761-06 Enoxaparin Sodium Injection USP 100 mg/1 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 1 mL Syringes NDC 11797-762-06 Enoxaparin Sodium Injection USP 120 mg/0.8 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 0. 8 mL Syringes NDC 11797-763-06 Enoxaparin Sodium Injection USP 150 mg/1 mL SINGLE-DOSE SYRINGES WITH AUTOMATIC SAFETY DEVICE FOR SUBCUTANEOUS INJECTION Ten 1 mL Syringes
The typical volume of the injection in milliliters (ml) for a single dose of Low Molecular Weight Heparin (LMWH) ranges from 0.3 mL to 1 mL.
- The available volumes are:
- 0.3 mL for 30 mg
- 0.4 mL for 40 mg
- 0.6 mL for 60 mg
- 0.8 mL for 80 mg and 120 mg
- 1 mL for 100 mg and 150 mg However, the FDA drug label does not provide information on whether a single dose can be administered at two different sites 1.
From the Research
Yes, a single dose of Low Molecular Weight Heparin (LMWH) can be administered at two different injection sites if the total volume exceeds 1 ml. The typical volume of LMWH injections ranges from 0.2 ml to 1 ml, depending on the specific product and prescribed dose, as seen in studies such as 2. For example, enoxaparin (Lovenox) typically comes in pre-filled syringes containing 0.2 ml to 0.8 ml of solution. If a higher dose is required resulting in a volume greater than 1 ml, it's recommended to split the dose between two separate injection sites to minimize local tissue trauma and improve absorption. When administering LMWH, use the subcutaneous route, typically in the anterolateral or posterolateral abdominal wall, at least 2 inches from the umbilicus. Alternate injection sites daily to prevent tissue damage. The entire needle should be inserted at a 90-degree angle into a pinched fold of skin, and the injection should be given slowly. After administration, don't massage the site as this may cause bruising. This split-dosing approach helps ensure proper drug absorption while minimizing patient discomfort, as supported by the most recent and highest quality study 2.
Some key points to consider when administering LMWH include:
- The dose and volume of the injection, which can vary depending on the specific product and patient needs, as discussed in 3 and 2.
- The injection site, which should be alternated daily to prevent tissue damage, as is standard practice.
- The technique for administering the injection, which should involve inserting the needle at a 90-degree angle and giving the injection slowly, as is typical for subcutaneous injections.
- The potential for bruising or other local reactions, which can be minimized by avoiding massage of the injection site, as noted in general clinical guidelines.
Overall, the administration of LMWH at two different injection sites can be a safe and effective way to manage patients who require high doses of this medication, as long as proper technique and precautions are followed, as supported by the evidence from 2.