From the Guidelines
Lovenox (enoxaparin) is derived from pork sources, as it is manufactured from standard heparin extracted from porcine intestinal mucosa. The manufacturing process of enoxaparin involves the extraction of heparin from pig intestines, which is then subjected to benzylation followed by alkaline depolymerization to produce the low molecular weight heparin fragments 1. This information is crucial for patients with religious or cultural restrictions regarding pork products, such as those following Islamic, Jewish, or certain vegetarian practices. For these patients, alternative anticoagulants may be considered depending on the clinical situation.
- The porcine origin of Lovenox relates to the manufacturing process, where heparin is extracted from pig intestines and then undergoes chemical depolymerization to create the lower molecular weight fragments that make up enoxaparin.
- Despite its porcine origin, many religious authorities have issued opinions permitting its use when medically necessary, as the original substance undergoes significant transformation during manufacturing 1.
- It is essential to consider the patient's beliefs and values when prescribing Lovenox, and alternative options should be discussed if necessary.
- The use of Lovenox should be weighed against the potential benefits and risks, taking into account the patient's individual circumstances and medical needs.
From the Research
Lovenox Derivation
- Lovenox, also known as enoxaparin, is a low molecular weight heparin (LMWH) used as an anticoagulant to prevent and treat venous thromboembolism events (VTE) 2.
- The derivation of Lovenox is primarily from porcine intestine heparin, as it is the only approved source for producing pharmaceutical heparin in most countries 3.
- However, there are studies exploring alternative sources, such as bovine lung heparin and ovine-derived heparin, due to potential supply shortages and economically motivated adulteration 3, 4.
- One study suggests that enoxaparin can be derived from bovine or porcine intestines and lungs, which may contribute to its potential to cause hypersensitivity reactions 5.
Enoxaparin Production
- Enoxaparin is prepared by benzylation and alkaline depolymerization from porcine intestine heparin 3.
- The production of enoxaparin from alternative sources, such as bovine lung heparin, has been explored, and the results suggest that the differences between porcine intestine heparin-derived enoxaparin and bovine lung heparin-derived enoxaparin mainly result from N-acetylation differences derived from the parent heparins 3.
- Ovine-derived low-molecular-weight heparin has also been compared to porcine-derived LMWH, and the results show that the pharmacokinetics of ovine enoxaparin are comparable to the branded product 4.
Clinical Use
- Enoxaparin is commonly prescribed for the chemoprophylaxis of venous thromboembolism in postoperative hip or knee replacement or abdominal surgery patients 5.
- It has been approved by the US FDA for use in patients with medically managed ST-segment elevation myocardial infarction (STEMI), or STEMI with subsequent percutaneous coronary intervention (PCI) 6.
- Enoxaparin has been shown to be more effective than unfractionated heparin in patients presenting with STEMI who underwent fibrinolytic therapy 6.