What is the treatment dose of Lovenox (enoxaparin)?

From the Guidelines

The recommended treatment dose of Lovenox (enoxaparin) is 1 mg/kg subcutaneously every 12 hours, as stated in the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1.

Key Considerations

• For patients with renal impairment (creatinine clearance <30 mL/min), the dose should be reduced to 1 mg/kg once daily, as recommended in the same guideline 1.
• Actual body weight should be used for dosing calculations, though some clinicians may consider adjusted dosing for morbidly obese patients.
• Common indications for Lovenox include treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and acute coronary syndromes.
• Treatment duration varies by indication but typically ranges from 5-10 days for acute conditions to 3-6 months for unprovoked DVT/PE.

Monitoring and Safety

• Patients should be monitored for bleeding complications, and anti-Xa levels may be checked in special populations like pregnant women, those with renal impairment, or at extremes of body weight.
• Lovenox works by binding to antithrombin and enhancing its inhibition of factor Xa, thereby preventing clot formation.
• Patients should be counseled on proper injection technique if self-administering and advised to report any unusual bleeding or bruising.

Additional Guidance

• The 2008 European Society of Cardiology guidelines for the diagnosis and management of acute pulmonary embolism also recommend enoxaparin doses of 1.0 mg/kg every 12 hours or 1.5 mg/kg once daily for the treatment of pulmonary embolism 1.
• The 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care provide additional guidance on the use of enoxaparin in patients with ST-elevation myocardial infarction, including dosing recommendations and considerations for patients with renal impairment 1.
• The 2008 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction also provides guidance on the use of enoxaparin in this patient population, including recommendations for dosing and administration 1.

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 available treatment doses of Lovenox (enoxaparin) are:

• 30 mg/0.3 mL
• 40 mg/0.4 mL
• 60 mg/0.6 mL
• 80 mg/0.8 mL
• 100 mg/1 mL
• 120 mg/0.8 mL
• 150 mg/1 mL 2

From the Research

Treatment Dose of Lovenox

• The treatment dose of Lovenox (enoxaparin) varies depending on the patient's condition and renal function.
• A study published in the Journal of Clinical Pharmacology 3 found that patients with creatinine clearance (CLCr) ≤ 30 mL/min had higher median antifactor Xa levels compared to those with CLCr > 31 mL/min, suggesting that a dose adjustment may be necessary in patients with severe renal impairment.
• The standard dose of enoxaparin for prophylaxis in medically ill patients is 40 mg/day, as shown in a study published in the American Journal of Cardiovascular Drugs 4.
• Another study published in Chest 5 compared the efficacy and safety of enoxaparin with unfractionated heparin (UFH) in patients with deep vein thrombosis (DVT) with or without pulmonary embolism (PE), and found that enoxaparin was noninferior to UFH in preventing VTE at 3 months.

Dosage Considerations

• Patients with renal impairment may require a dose adjustment, as enoxaparin is cleared by the kidneys 3.
• The dose of enoxaparin may also depend on the patient's weight, with a typical dose of 1 mg/kg subcutaneously every 12 hours 3.
• A study published in the Journal of Thrombosis and Thrombolysis 6 compared the prevalence of DVT and PE in patients admitted to the intensive care unit (ICU) who received unfractionated heparin (UFH) versus enoxaparin as VTE prophylaxis, and found that there was no difference in prevalence of DVT and PE between the two groups.

Clinical Guidelines

• The optimal duration of antithrombotic therapy to prevent recurrent venous thromboembolism (VTE) is still a topic of debate, with some studies suggesting that shorter courses of anticoagulation may be more beneficial for primary treatment 7.
• However, for secondary prevention of unprovoked VTE or VTE provoked by chronic risk factors, indefinite antithrombotic treatment may be more beneficial 7.