What is the maximum recommended dose of enoxaparin (Lovenox)?

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Last updated: February 24, 2026View editorial policy

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Maximum Dose of Enoxaparin (Lovenox)

The maximum single dose of enoxaparin varies by indication: for prophylaxis, the first two subcutaneous doses should not exceed 100 mg in patients <75 years receiving fibrinolytic therapy, and 75 mg in patients ≥75 years; for therapeutic anticoagulation, there is no absolute maximum dose, but weight-based dosing of 1 mg/kg every 12 hours or 1.5 mg/kg once daily is standard, with dose caps applied in specific clinical contexts.

Context-Specific Maximum Dosing

Prophylactic Dosing

  • Standard prophylactic enoxaparin is 40 mg subcutaneously once daily for most hospitalized medical and surgical patients 1, 2
  • In patients with severe renal impairment (CrCl <30 mL/min), the maximum prophylactic dose is reduced to 30 mg once daily to prevent drug accumulation and 2–3-fold increased bleeding risk 1, 3, 2
  • For obese patients (BMI ≥40 kg/m²), intermediate prophylactic dosing of 40 mg every 12 hours may be used, but this represents the upper limit for prophylaxis 1

Therapeutic Dosing in Acute Coronary Syndromes

  • In patients <75 years receiving fibrinolytic therapy, enoxaparin dosing is 30 mg IV bolus followed by 1 mg/kg subcutaneously every 12 hours, with the first two subcutaneous doses capped at 100 mg each 4
  • In patients ≥75 years receiving fibrinolytic therapy, the IV bolus is omitted and dosing is reduced to 0.75 mg/kg subcutaneously every 12 hours with a maximum of 75 mg for the first two doses 4, 1
  • For primary PCI, enoxaparin is given as a single 0.5 mg/kg IV bolus with no specified maximum 4

Therapeutic Dosing for Venous Thromboembolism

  • Standard therapeutic regimens are 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg once daily with no absolute maximum dose in patients with normal renal function 4, 1, 5
  • In severe renal impairment (CrCl <30 mL/min), therapeutic dosing is reduced to 1 mg/kg once daily (a 50% reduction in total daily dose) 1, 3, 2
  • For patients with BMI ≥40 kg/m², dose-adjusted regimens use 0.8 mg/kg every 12 hours rather than standard 1 mg/kg dosing 1

Critical Dose-Capping Rationale

Why Dose Caps Exist in Specific Populations

Elderly patients receiving fibrinolysis: The 75 mg cap for patients ≥75 years reflects the substantially higher bleeding risk in this population, where standard dosing would lead to excessive anticoagulation 4, 1

Renal impairment: Enoxaparin clearance decreases by 31% in moderate renal impairment (CrCl 30–60 mL/min) and 44% in severe renal impairment (CrCl <30 mL/min), resulting in drug accumulation and 2–3-fold increased major bleeding risk without dose reduction 1, 3, 2

Obesity considerations: While there is no absolute maximum dose for obese patients, weight-based dosing in extreme obesity may require anti-Xa monitoring to ensure appropriate anticoagulation without excessive bleeding 1

Monitoring and Safety Thresholds

  • Anti-Xa monitoring is recommended in patients with severe renal impairment (CrCl <30 mL/min) receiving prolonged therapy, targeting 0.5–1.5 IU/mL measured 4–6 hours after the dose, after 3–4 consecutive doses 1, 3, 2
  • For prophylactic dosing, target anti-Xa levels are 0.2–0.5 IU/mL 1
  • For therapeutic twice-daily dosing, target anti-Xa levels are 0.5–1.0 IU/mL 1, 3
  • For therapeutic once-daily dosing, target peak anti-Xa levels are 1.0–1.5 IU/mL 1

Common Pitfalls Regarding Maximum Dosing

Failure to cap doses in elderly patients with STEMI: Using standard 1 mg/kg dosing (up to 100 mg) in patients ≥75 years receiving fibrinolysis dramatically increases intracranial hemorrhage risk; the 75 mg cap is mandatory 4, 1

Not reducing doses in renal impairment: The most frequent dosing error is using standard prophylactic (40 mg daily) or therapeutic (1 mg/kg every 12 hours) dosing in patients with CrCl <30 mL/min, leading to dangerous drug accumulation 1, 3, 2

Assuming a universal maximum exists: Unlike some medications, enoxaparin does not have a single "maximum dose"—the ceiling varies by indication, patient age, renal function, and body weight 4, 1

Overlooking the 100 mg cap in fibrinolysis protocols: Even in younger patients (<75 years) with normal renal function receiving fibrinolytic therapy for STEMI, the first two subcutaneous doses are capped at 100 mg each to balance efficacy and bleeding risk 4

References

Guideline

Enoxaparin Dosing and Administration for DVT Prophylaxis and Stroke Prevention

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Enoxaparin Dosing Considerations in Renal Impairment

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Enoxaparin Dosing Considerations in Renal Impairment

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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