Enoxaparin is used to prevent blood clots in the leg in patients who are on bedrest or who are having hip replacement, knee replacement, or stomach surgery. It is used in combination with aspirin to prevent complications from angina (chest pain) and heart attacks. It is also used in combination with warfarin to treat blood clots in the leg. Enoxaparin is in a class of medications called low molecular weight heparins. It works by stopping the formation of substances that cause clots.

If you have epidural or spinal anesthesia or a spinal puncture while taking a 'blood thinner' such as enoxaparin, you are at risk for having a blood clot form in or around your spine that could cause you to become paralyzed. Tell your doctor if you are taking other anticoagulants ('blood thinners') such as warfarin (Coumadin), anagrelide (Agrylin), aspirin or nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen), cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine), eptifibatide (Integrilin), prasugrel (Effient), sulfinpyrazone (Anturane), ticlopidine (Ticlid), and tirofiban (Aggrastat).

If you experience any of the following symptoms, call your doctor immediately: numbness, tingling, leg weakness or paralysis, and loss of control over your bladder or bowels.

Talk to your doctor about the risk of taking enoxaparin. Keep all appointments with your doctor.

Enoxaparin comes as an injection in a syringe to be injected just under the skin (subcutaneously) but not into your muscle. It is usually given twice a day. You will probably begin using the drug while you are in the hospital and then use it for a total of 10 to 14 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use enoxaparin exactly as directed. Do not inject more or less of it or inject it more often than prescribed by your doctor.

Continue to use enoxaparin even if you feel well. Do not stop taking enoxaparin without talking to your doctor.

Your healthcare provider will teach you how to give yourself the shot or arrangements will be made for someone else to give you the shot. Enoxaparin is usually injected in the stomach area. You must use a different area of the stomach each time you give the shot. If you have questions about where to give the shot, ask your healthcare provider. Each syringe has enough drug in it for one shot. Do not use the syringe and needle more than one time. Your doctor, pharmacist, or health care provider will tell you how to dispose of used needles and syringes to avoid accidental injury. Keep syringes and needles out of reach of children.

To inject enoxaparin, follow these instructions:

1. Wash your hands and the area of skin where you will give the shot.
2. Look at the syringe to be sure the drug is clear and colorless or pale yellow.
3. Take the cap off the needle. Do not push any air or drug out of the syringe before giving the shot unless your healthcare provider tells you to.
4. Lie down and pinch a fold of skin between your finger and thumb. Push the entire needle into the skin and then press down on the syringe plunger to inject the drug. Hold onto the skin the entire time you give the shot. Do not rub the site after you give the shot.

Before taking enoxaparin,

• tell your doctor and pharmacist if you are allergic to enoxaparin, heparin, any other drugs, or pork products.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially those listed in the IMPORTANT WARNING section and vitamins.
• tell your doctor if you have an artificial heart valve and if you have or have ever had kidney disease, an infection in your heart, a stroke, a bleeding disorder, ulcers, or a low platelet count.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking enoxaparin, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking enoxaparin.

Inject the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not inject a double dose to make up for a missed one.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep this medication out of reach of children. Store the syringes at room temperature and away from excess heat and moisture (not in the bathroom). Do not use the syringe if it leaks or if the fluid is dark or contains particles.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Enoxaparin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• fever
• irritation or burning at site of injection

If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• unusual bleeding or bruising
• black or bloody stools
• blood in urine
• swollen ankles and/or feet

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to monitor your enoxaparin therapy.

Enoxaparin prevents blood from clotting so it may take longer than usual for you to stop bleeding if you are cut or injured. Avoid activities that have a high risk of causing injury. Call your doctor if bleeding is unusual.

Do not let anyone else use your medication. Your prescription is probably not refillable.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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