Enoxaparin is an anticoagulant that helps prevent the formation of blood clots.

Enoxaparin is used to treat or prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery, or in people who are bed-ridden due to a prolonged illness.

Enoxaparin is also used to prevent blood vessel complications in people with certain types of angina (chest pain) or heart attack.

Enoxaparin may also be used for purposes not listed in this medication guide.

Enoxaparin can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, a history of spinal surgery or repeated spinal taps, or if you are using other drugs that can affect blood clotting, including blood thinners or NSAIDs (ibuprofen, Advil, Aleve, and others). This type of blood clot can lead to long-term or permanent paralysis.

Get emergency medical help if you have symptoms of a spinal cord blood clot such as back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Enoxaparin is injected under the skin, or as an infusion into a vein. A healthcare provider may teach you how to properly use the medication by yourself.

Read and carefully follow any Instructions for Use provided with your medicine. Do not use enoxaparin if you don't understand all instructions for proper use. Ask your doctor or pharmacist if you have questions.

Prepare your injection only when you are ready to give it. Do not use if the medicine has changed colors, or has particles in it. Call your pharmacist for new medicine.

You should be sitting or lying down during the injection. Do not inject enoxaparin into a muscle.

Your care provider will show you where on your body to inject enoxaparin. Use a different place each time you give an injection. Do not inject into the same place two times in a row.

You will need frequent medical tests to help your doctor determine how long to treat you with enoxaparin.

If you need surgery or dental work, tell your surgeon or dentist you currently use this medicine. You may need to stop for a short time.

Store at room temperature away from moisture and heat.

Each single-use prefilled syringe is for one use only. Throw it away after one use, even if there is still medicine left inside.

After your first use of an enoxaparin vial (bottle), you must use the medicine within 28 days. Throw away the vial after 28 days.

Use a needle and syringe only once and then place them in a puncture-proof "sharps" container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.

You should not use enoxaparin if you are allergic to enoxaparin, heparin, benzyl alcohol, or pork products, or if you have:

• active or uncontrolled bleeding; or

• if you had decreased platelets in your blood after testing positive for a certain antibody while using enoxaparin within the past 100 days.

Enoxaparin may cause you to bleed more easily, especially if you have:

• a bleeding disorder that is inherited or caused by disease;

• hemorrhagic stroke;

• an infection of the lining of your heart (also called bacterial endocarditis);

• stomach or intestinal bleeding or ulcer; or

• recent brain, spine, or eye surgery.

Enoxaparin can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term or permanent paralysis, and may be more likely to occur if:

• you have a spinal cord injury;

• you have a spinal catheter in place or if a catheter has been recently removed;

• you have a history of spinal surgery or repeated spinal taps;

• you have recently had a spinal tap or epidural anesthesia;

• you take aspirin or an NSAID (nonsteroidal anti-inflammatory drug)--ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, indomethacin, meloxicam, and others; or

• you are using a blood thinner (warfarin, Coumadin) or other medicines to treat or prevent blood clots.

Tell your doctor if you have ever had:

• a bleeding disorder such as hemophilia;

• kidney or liver disease;

• uncontrolled high blood pressure;

• eye problems caused by diabetes;

• a stomach ulcer; or

• low blood platelets after receiving heparin.

Tell your doctor if you are pregnant. If you use enoxaparin during pregnancy, make sure your doctor knows if you have a mechanical heart valve.

It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose may cause excessive bleeding.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Get emergency medical help if you have signs of an allergic reaction: hives; itching or burning skin; difficult breathing; swelling of your face, lips, tongue, or throat.

Also seek emergency medical attention if you have symptoms of a spinal blood clot: back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Enoxaparin may cause serious side effects. Call your doctor at once if you have:

• unusual bleeding, or any bleeding that will not stop;

• easy bruising, purple or red spots under your skin;

• nosebleeds, bleeding gums;

• abnormal vaginal bleeding, blood in your urine or stools;

• coughing up blood or vomit that looks like coffee grounds;

• signs of bleeding in the brain--sudden weakness (especially on one side of the body), sudden severe headache, problems with speech or vision; or

• low red blood cells (anemia)--pale skin, unusual tiredness, feeling light-headed or short of breath, cold hands and feet.

Common side effects of enoxaparin may include:

• nausea, diarrhea;

• anemia;

• confusion; or

• pain, bruising, redness, or irritation where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Tell your doctor about all your other medicines, especially other medicines to treat or prevent blood clots, such as:

• abciximab, anagrelide, cilostazol, clopidogrel, dipyridamole, eptifibatide, ticlopidine, tirofiban;

• alteplase, reteplase, tenecteplase, urokinase;

• apixaban, argatroban, bivalirudin, dabigatran, desirudin, fondaparinux, lepirudin, rivaroxaban, tinzaparin; or

• heparin.

This list is not complete. Other drugs may affect enoxaparin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.