Thrombotic disorders in an advanced state with a probability of 25% will lead to death. To prevent such consequences, many antithrombotic drugs are already on the market, one of which is based on active enoxaparin sodium. But it is necessary to carefully study the instructions for use of Enixum - anticoagulants have a long list of side effects.
Material Content:
- 1 Description, dosage forms and composition
- 2 Pharmacological properties and pharmacokinetics
- 3 In what cases is Enixum prescribed
- 4 Instructions for the use of injections
- 5 How to use a spring syringe
- 6 During pregnancy and lactation
- 7 Drug interaction
- 8 Contraindications, side effects and overdose
- 9 Analogues of the drug
Description, dosage forms and composition
The drug is suitable only for intravenous or subcutaneous administration. Sold in the form of Enixum syringes and standard glass ampoules. It is presented in different volumes, starting with 0.2 ml and ending with 1 ml. Each ampoule or syringe contains from 20 mg to 100 mg of the active ingredient, enoxaparin sodium. The color of the liquid may also vary: completely transparent, with a slight brown tint or slightly yellowish.
The only additional component is water for injection.
Pharmacological properties and pharmacokinetics
Enoxaparin is a copy of heparin, but low molecular weight. This "kinship" determines the affiliation of the described substance to direct-acting anticoagulants. This means that taking enoxaparin-based drugs does not affect platelet production, but only reduces their plasma activity. It is activated when interacting with two coagulation factors - Xa and IIa.
These factors are proteins that are contained in platelets and are responsible for the functioning of the blood coagulation mechanism.
Moreover, the effect on the Xa factor is almost 10 times greater than a similar reaction with the IIa factor. The first type of interaction is activated 3 or 4 hours after the dose of the drug and reaches 0.13-0.19 international units (ME - units of activity of the substance) per 1 ml. The second type appears after 4-5 hours, but its value varies from 0.2 IU / ml to 1.3 IU / ml.
The bioavailability of enoxaparin is almost 100%, which characterizes the drug as effective for the treatment of thrombosis of various nature. Evenly distributed in the blood (distribution volume - up to 5 l).
It is processed in the liver to form inactive metabolites. The half-life varies for people who are using the drug for the first time, and for those who have been on similar therapy for a long time. For the first group, the indicator is 4 hours, for the second - 7 hours. It is excreted by the kidneys.
There is a correction for the patient’s body weight: in women weighing up to 45 kg and men up to 57 kg, activity (especially in relation to the X factor) is twice as high as in people with average statistics.
Accordingly, the larger the mass, the less active enoxaparin sodium will be.
In what cases is Enixum prescribed
Stabbing Enixum is necessary in the following cases:
- the presence of blood clots in deep veins, especially accompanied by pulmonary thromboembolism (clogging of a pulmonary vein with blood clots, which leads to a restriction of oxygen supply to the lungs, and a person suffocates);
- small focal infarction and unstable angina;
- viral or bacterial infections, against the background of which the likelihood of developing venous thrombosis increases;
- severe rheumatic disorders, as a result of which thrombotic pathologies may form;
- prevention in the postoperative state (especially after orthopedic interventions), which increases the risk of blood clots and thromboembolism;
- prolonged stay in bed with severe forms of heart or respiratory failure;
- acute form of myocardial infarction (transmural type).
Instructions for the use of injections
For all items indicated as indications, a special dosage system is provided. Enixum is administered through deep subcutaneous or intravenous injection.
You can not do injections based on the drug intramuscularly.
Enixum is a drug for quick relief with a high probability of aggravation or development of thrombotic disorders. Treatment, as a rule, lasts no more than two weeks - the doctor will specify the course. After using this tool, it is recommended to switch to oral anticoagulants.
Enter Enixum once a day. For patients who do not have thrombotic diseases, but the risk of their development is characterized as moderate, prescribe from 20 to 40 mg of the substance sc (subcutaneously). People who have a higher predisposition to blood clots are credited with 40 mg of the drug sc.
The dose is similar for infectious (bacterial / viral) or rheumatic diseases when the patient is on bed rest.
For the treatment of venous thrombosis, dose adjustment relative to body weight is necessary. The route of administration is s / c, the required volume of the substance is 1 mg per kg of patient weight. It is important to monitor the anti-Xa activity of the drug to prevent possible side effects. After the course of treatment with Enixum (about 10 days), switch to oral anticoagulants.
According to a similar scheme, the dose is calculated in the treatment of small focal heart attack and angina pectoris (unstable). Therapy is carried out in combination with acetylsalicylic acid. The interval between administrations is 12 hours.
During treatment of transmural infarction, therapy begins with a bolus (in a large volume) injection. The drug should enter the vein with a glass syringe with a volume of 40 to 100 mg. Dose - 30 mg.Next - the reception according to the above norm: 1 mg of enoxaparin per kilogram of body weight, but administered subcutaneously. The time intervals between the procedures - 12 hours.
For elderly patients with this treatment, Enixum bolus injections are contraindicated, and the dose per kilogram of weight must be reduced to 0.75 mg.
Patients with impaired excretory system will also need to adjust the amount of the drug administered, and people with acute liver failure should be careful with such treatment.
How to use a spring syringe
It is important to consider the method of administering the drug under the skin. In pharmacies, you can find special syringes with a spring that are already filled with the drug. The advantage of this form of release is increased safety - the needle itself "hides" after the introduction of the required dose. This prevents injuries with a sharp object.
Using a syringe is easy: with a small amount of effort, remove the cap from the needle.
The tip cannot be in contact with non-sterile objects or surfaces.
In most cases, in order to prevent air from entering the puncture site, it is recommended to shake the syringe, holding it with the needle up, and release a little preparation to remove the bubbles. But in the case of enoxaparin injections, it is better not to do this.
The injection site is the lower or upper abdomen. With each injection, the left or right walls alternate.
A small area of the skin is firmly pinched with fingers until a high fold is formed, the place is disinfected. The needle is inserted vertically, in full length. Press the piston smoothly, at an average pace. Additional pressing will cause the needle to “hide”. After the injection, the damaged area cannot be massaged.
During pregnancy and lactation
Although there is insufficient data on the effect of the drug on the baby’s body, doctors are wary of using Enixum during pregnancy, as other anticoagulants negatively affect the fetus.
It is strictly forbidden to administer the drug if the mother has a prosthetic heart valve.
There is also no evidence of whether enoxaparin passes into breast milk. If therapeutic doses are observed, the effect of the drug on the child is unlikely, but doctors recommend stopping breastfeeding for the duration of treatment.
Drug interaction
During the use of Enixum, in no case should you mix it in a syringe with other drugs.
Possible interaction of active agents with enoxaparin is described in the table.
| Medicine | Consequences for the body after combination with Enixum |
|---|---|
| Painkillers Salicylates | High probability of internal bleeding |
| Nonsteroidal anti-inflammatory drugs | Damage to the mucous membranes of the stomach and intestines, as a result, gastrointestinal hemorrhages |
| Diuretics (especially those that interfere with the elimination of potassium from the body), cyclosporine, trimethoprim | Excess potassium in the body |
| Dextran | The appearance of internal bleeding |
Contraindications, side effects and overdose
Among the contraindications:
- significant bleeding in the body, the risk of its occurrence after or during operations, the presence of cerebral cerebral aneurysm, severe injuries;
- thrombocytopenia (low platelet count) and positive antiplatelet antibody test results;
- pregnancy of a woman with a prosthetic heart valve;
- an allergic reaction to enoxaparin or related substances (heparin, other direct-acting anticoagulants);
- minor age (use for children under 18 has not been studied, therefore, is contraindicated).
With caution, treatment should be taken in the following cases:
- pathology of hemostasis: severe thrombocytopenia, hemophilia (hereditary sparseness of the blood), von Willebrand-Dian syndrome (occasionally hemorrhage throughout the body), hypocoagulation (low ability of blood to coagulate),severe forms of vasculitis (vascular inflammation);
- uncontrolled hypertension, post-stroke condition, microbial endocarditis, pericarditis;
- the presence of ulcers on the mucous membranes of the intestines or stomach;
- severe course of diabetes;
- retinopathy (retinal damage) - hemorrhagic (due to changes in the blood test), diabetic;
- future or past ophthalmic or neurological surgery;
- the upcoming introduction of epidural or spinal anesthesia;
- the availability of intrauterine contraceptives;
- renal / liver failure.
Side effects from the drug are classified by the criterion of how often they occur in patients, as shown in the table below.
| Type of symptom | Description |
|---|---|
| Very frequent | Thrombocytosis, bleeding of various nature, activation of the action of liver enzymes |
| Frequent | Nasal blood, thrombocytopenia, an allergy in the form of redness on the skin with itching and hives, hematomas and painful areas can form at the injection site |
| Infrequent | Severe retroperitoneal bleeding, bullous rash (rash in the form of vesicles), necrosis at the injection site |
| Rare | Anaphylactic edema or anaphylactoid reactions, increased levels of potassium in the blood, severe hemorrhage |
| Very rare | Autoimmune thrombocytopenia, possible in combination with thrombosis |
Small hard vesicles can also be found at the injection site - they disappear after a day or two, so they are not a cause for concern and refusal of the drug. But if necrosis has formed, treatment and subsequent rejection of the drug are necessary.
There is information about the use of Enixum against the background of the types of anesthesia indicated in contraindications. As a result, a severe form of hematoma (neuroaxial, spinal) was formed, which required immediate medical intervention.
With an overdose, hemorrhagic disorders are observed. They are eliminated by taking protamine sulfate if 8 hours have not passed after an overdose of enoxaparin. 1 mg of the drug neutralizes the effect of the same volume of Enixum. But this drug has a large number of side effects, so only a doctor should take this decision, taking into account all the advantages and risks.
Analogues of the drug
Direct analogues of Enixum are all drugs that are based on enoxaparin sodium. They have similar indications for use, side effects and contraindications.
One of such tools is the domestic drug Anfibra. Among imported drugs, Gemapaxan and Fraxiparin should be distinguished, the French version of the anticoagulant is Clexane, all of them are available in the form of solutions for subcutaneous administration.
Fragmin is a drug of German origin, based on dalteparin sodium, another low molecular weight heparin, therefore side effects and contraindications are similar, but the dosages are different.
Angioflux is a domestic remedy where the main activity is provided by sulodexide. Differences in composition cause different effects on the body and a wider range of indications. Since the drug is intended for oral use, dyspeptic disorders are added to the list of side effects.
The Italian analogue has the same composition - Wessel Douay F. It is often prescribed after short-term therapy with Enixum.
You should not choose a substitute yourself. Ignorance of the characteristics of the interaction of certain substances in the composition can adversely affect the health and course of existing diseases. Consult a specialist with advice.
Treatment with anticoagulants requires extreme caution due to the large number of adverse reactions. Therefore, before therapy with Enixum, it is important to study the drug and accurately follow all the doctor’s instructions throughout the course of therapy.
