Enoxaparin Sodium (Enclex)

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 Composition:

   Enclex 40: Each prefilled syringe contains

  • Enoxaparin Sodium IP -40mg
  • Water for injection IP -0.4ml
  Enclex 60 : Each prefilled syringe contains 

  1. Enoxaparin sodium Sodium IP -60mg
  2. Water for injection IP - 0.6ml
Dosage form: Pre-filled syringe 

Pharmacology:
 Enoxaparin is a low-molecular weight heparin ,which has anti- thrombotic properties .In humans, enoxaparin given as a subcutaneous dose of 1.5 mg/kg is characterized by a higher ratio of anti- Factor X a to anti-Factor II a activity.

Distribution:
     
  The volume of distribution of anti- Factor Xa activity is about 4.3 litres

Metabolism:

  Enoxaparin Sodium is primarily metabolized in the liver by desulfation and /or depolymerization to lower molecular weight species with much reduced biological potency.Renal clearance of active fragments represents about 10% of the administered dose and total renal excretion of active and non-active fragments 40% of the dose .

Elimination: 
  
   Following IV dosing, the total body clearance of enoxaparin is 26 ml/min. After IV dosing of enoxaparin labeled with the gamma -emitter .

Indication:
 Prophylaxis of DVT, which may lead to PE
  • Abdominal surgery- Initial dose - Enclex 40mg -- prior to surgery(2hrs), Maintanence dose---1 in a day (7-10 days)
  • Hip (or) Knee replacement surgery--Initial dose---Enclex 40 mg ----prior to surgery (12hrs), Maintenance dose--3 weeks (1 in day)
  • Medical patients during acute illness:Enclex 40 mg (1  in a day) 
Treatment of DVT with (or) without PE:
Impatient and outpatient with (or)without PE , when administered in conjunction with Warfarin sodium -1mg /kg
  • Unstable Angina- Enoxaparin is indicated for the prophylaxis of ischemic complication of unstable angina and non-Q wave myocardial infarction,  when concurrently administered with aspirin.
  • Treatment of Acute STEMI: In patients with acute STEMI, the recommended dose of Enclex is a single IV bolis of 30 mg plus a 1 mg/kg SC dose followed by a 1 mg/kg Sc dose every 12 hrs.Dosage adjustments are recommended in patients greater than or equal to 75 yrs of age. All patients should receive aspirin as soon as they are identified as having STEMI are maintained with 75--325mg once daily unless contraindicated.
  • Patients managed with PCI: If the last Enclex SC administration was given less  than 8 hrs before balloon inflation, no additional dosing is needed. If the last Enclex SC administration, was given greater than 8 hrs before balloon inflation , an IV bolus of 0.3 mg/kg of Enclex should be administered.
Contraindication:
  1. Active major bleeding
  2. Thrombocytopenia
  3. Hypersensitivity to heparin (or) pork products
  4. Hypersensitivity to enoxaparin sodium (eg.Pruritis, Urticaria, anaphylactic reaction)

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