Lovenox Does Not Cause Elevated Calcium
Lovenox (enoxaparin) is not associated with hypercalcemia and does not cause elevated calcium levels. There is no evidence in the medical literature linking enoxaparin to hypercalcemia, and it is not listed among the known causes of elevated calcium.
Known Causes of Hypercalcemia
The evidence provided focuses entirely on hypercalcemia management and etiology, with no mention of low molecular weight heparins like enoxaparin as causative agents. The established causes of hypercalcemia include:
Primary Causes (>90% of cases)
- Primary hyperparathyroidism - accounts for approximately 90% of hypercalcemia cases along with malignancy 1, 2
- Malignancy - responsible for the other major portion of hypercalcemia cases, typically presenting with rapid onset and higher calcium levels 1, 2
Medication-Related Causes
The medications and supplements that actually cause hypercalcemia include:
- Thiazide diuretics - increase calcium reabsorption in renal tubules 1, 3
- Vitamin D supplements - increase intestinal calcium absorption when taken in excess 1, 3
- Calcium supplements - particularly when exceeding 500 mg/day 4, 1
- Vitamin A - causes increased bone resorption in toxic doses 1, 3
- Calcitriol and vitamin D analogues (paricalcitol) - episodes of hypercalcemia occurred in 22.6-43.3% of patients in clinical trials 5
- Lithium - mentioned as a potential cause 4
Other Causes
- Granulomatous diseases (sarcoidosis) - cause excessive intestinal calcium absorption 1, 6
- Endocrinopathies including thyroid disease 1
- Immobilization - reduces bone formation relative to resorption 1
- Denosumab discontinuation - accounts for less than 1% of cases 1
Clinical Context
If you are evaluating a patient on Lovenox with elevated calcium, you should look for alternative explanations:
- Measure intact PTH to distinguish PTH-dependent (elevated/normal PTH suggests primary hyperparathyroidism) from PTH-independent causes (suppressed PTH <20 pg/mL indicates malignancy or other causes) 4, 1
- Review all medications including thiazides, calcium supplements, vitamin D supplements, and lithium 4, 1
- Assess for malignancy particularly in patients with rapid onset hypercalcemia, higher calcium levels (>12 mg/dL), and marked anemia 2
- Check albumin levels to calculate corrected calcium: Corrected calcium (mg/dL) = Total calcium + 0.8 × [4.0 - Serum albumin] 4
Important Caveat
Patiromer (a potassium binder) can cause hypercalcemia because it contains a calcium-sorbitol counterion that exchanges calcium for potassium in the colon 5. This is a rare but documented adverse effect that clinicians should be aware of when initiating patiromer therapy 5. However, this is unrelated to Lovenox/enoxaparin.