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CLEXANE FORTE SYRINGES is a brand name for Enoxaparin. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Clexane Forte Syringes is indicated in adults for: • Prophylaxis of venous thromboembolic disease in moderate and high-risk surgical patients, in particular those undergoing orthopaedic or general surgery including cancer surgery. • Prophylaxis of venous thromboembolic disease in medical patients with an acute illness…
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Prophylaxis of venous thromboembolic disease in moderate and high-risk surgical patients Individual thromboembolic risk for patients can be estimated using validated risk stratification model. • In patients at moderate risk of thromboembolism, the recommended dose of enoxaparin sodium is 2,000 IU (20 mg) once daily by subcutaneous (SC) injection.
Preoperative initiation (2 hours before surgery) of enoxaparin sodium 2,000 IU (20 mg) was proven effective and safe in moderate risk surgery. g. mobility). Prophylaxis should be continued until the patient no longer has significantly reduced mobility.
• In patients at high risk of thromboembolism, the recommended dose of enoxaparin sodium is 4,000 IU (40 mg) once daily given by SC injection preferably started 12 hours before surgery. g. high risk patient waiting for a deferred orthopaedic surgery), the last injection should be administered no later than 12 hours prior to surgery and resumed 12 hours after surgery.
o For patients who undergo major orthopaedic surgery an extended thromboprophylaxis up to 5 weeks is recommended. o For patients with a high venous thromboembolism (VTE) risk who undergo abdominal or pelvic surgery for cancer an extended thromboprophylaxis up to 4 weeks is recommended.
Prophylaxis of venous thromboembolism in medical patients The recommended dose of enoxaparin sodium is 4,000 IU (40 mg) once daily by SC injection. g. mobility). The benefit is not established for a treatment longer than 14 days. 5 mg/kg) or as twice daily injections of 100 IU/kg (1 mg/kg).
The regimen should be selected by the physician based on an individual assessment including evaluation of the thromboembolic risk and of the risk of bleeding. 5 mg/kg) administered once daily should be used in uncomplicated patients with low risk of VTE recurrence.
The dose regimen of 100 IU/kg (1 mg/kg) administered twice daily should be used in all other patients such as those with obesity, with symptomatic PE, cancer, recurrent VTE or proximal (vena iliaca) thrombosis. Enoxaparin sodium treatment is prescribed for an average period of 10 days.
2). In the extended treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and prevention of its recurrence in patients with active cancer, physicians should carefully assess the individual thromboembolic and bleeding risks of the patient.
Summary of the safety profile Enoxaparin sodium has been evaluated in more than 15,000 patients who received enoxaparin sodium in clinical trials. These included 1,776 for prophylaxis of deep vein thrombosis following orthopaedic or abdominal surgery in patients at risk for thromboembolic complications, 1,169 for prophylaxis of deep vein thrombosis in acutely ill medical patients with severely restricted mobility, 559 for treatment of DVT with or without PE, 1,578 for treatment of unstable angina and non-Q-wave myocardial infarction and 10,176 for treatment of acute STEMI.
Enoxaparin sodium regimen administered during these clinical trials varies depending on indications. The enoxaparin sodium dose was 4,000 IU (40 mg) SC once daily for prophylaxis of deep vein thrombosis following surgery or in acutely ill medical patients with severely restricted mobility.
5 mg/kg) SC dose once a day. In the clinical studies for treatment of unstable angina and non-Q-wave myocardial infarction, doses were 100 IU/kg (1 mg/kg) SC every 12 hours, and in the clinical study for treatment of acute STEMI enoxaparin sodium regimen was a 3,000 IU (30 mg) IV bolus followed by 100 IU/kg (1 mg/kg) SC every 12 hours.
4 and 'Description of selected adverse reactions' below). The safety profile of enoxaparin for extended treatment of DVT and PE in patients with active cancer is similar to its safety profile for the treatment of DVT and PE. 4). Tabulated summary list of adverse reactions Other adverse reactions observed in clinical studies and reported in post- marketing experience (* indicates reactions from post-marketing experience) are detailed below.
Frequencies are defined as follows: very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1000 to < 1/100); rare (≥ 1/10,000 to <1/1,000); and very rare (< 1/10,000) or not known (cannot be estimated from available data).
4. 4). 2) Severe renal impairment Enoxaparin sodium is not recommended for patients with end stage renal disease (creatinine clearance <15 ml/min) due to lack of data in this population outside the prevention of thrombus formation in extracorporeal circulation during haemodialysis.
Dosage table for patients with severe renal impairment (creatinine clearance [15 – 30] ml/min): Indication Dosing regimen Prophylaxis of venous thromboembolic disease 2,000 IU (20 mg) SC once daily Treatment of DVT and PE 100 IU/kg (1 mg/kg) body weight SC once daily Extended treatment of DVT and PE in patients with active cancer 100 IU/kg (1 mg/kg) body weight SC once daily Treatment of unstable angina and NSTEMI 100 IU/kg (1 mg/kg) body weight SC once daily Treatment of acute STEMI (patients under 75) Treatment of acute STEMI (patients over 75) 1 x 3,000 IU (30 mg) IV bolus plus 100 IU/kg (1 mg/kg) body weight SC and then 100 IU/kg (1 mg/kg) body weight SC every 24 hours No IV initial bolus, 100 IU/kg (1 mg/kg) body weight SC and then 100 IU/kg (1 mg/kg) body weight SC every 24 hours The recommended dosage adjustments do not apply to the haemodialysis indication.
Moderate and mild renal impairment Although no dose adjustment is recommended in patients with moderate (creatinine clearance 30 – 50 ml/min) and mild (creatinine clearance 50 – 80 ml/min) renal impairment, careful clinical monitoring is advised.
Method of administration Clexane Forte Syringes should not be administered by the intramuscular route. For the prophylaxis of venous thrombo-embolic disease following surgery, treatment of DVT and PE, extended treatment of DVT and PE in patients with active cancer, treatment of unstable angina and NSTEMI, enoxaparin sodium should be administered by SC injection.
• For acute STEMI, treatment is to be initiated with a single IV bolus injection immediately followed by a SC injection. • For the prevention of thrombus formation in the extracorporeal circulation during haemodialysis, it is administered through the arterial line of a dialysis circuit.
4).
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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5 mg/kg) once daily SC injection up to 6 months. The benefit of continuous anticoagulant therapy should be reassessed after 6 months of treatment. Prevention of thrombus formation during haemodialysis The recommended dose is 100 IU/kg (1 mg/kg) of enoxaparin sodium.
75 mg/kg) for single vascular access. During haemodialysis, enoxaparin sodium should be introduced into the arterial line of the circuit at the beginning of the dialysis session. 5 to 1 mg/kg) may be given. No data are available in patients using enoxaparin sodium for prophylaxis or treatment and during haemodialysis sessions.
Acute coronary syndrome: treatment of unstable angina and NSTEMI and treatment of acute STEMI • For treatment of unstable angina and NSTEMI, the recommended dose of enoxaparin sodium is 100 IU/kg (1 mg/kg) every 12 hours by SC injection administered in combination with antiplatelet therapy.
Treatment should be maintained for a minimum of 2 days and continued until clinical stabilization. The usual duration of treatment is 2 to 8 days. Acetylsalicylic acid is recommended for all patients without contraindications at an initial oral loading dose of 150 – 300 mg (in acetylsalicylic acid-naive patients) and a maintenance dose of 75 – 325 mg/day long-term regardless of treatment strategy.
• For treatment of acute STEMI, the recommended dose of enoxaparin sodium is a single intravenous (IV) bolus of 3,000 IU (30 mg) plus a 100 IU/kg (1 mg/kg) SC dose followed by 100 IU/kg (1 mg/kg) administered SC every 12 hours (maximum 10,000 IU (100 mg) for each of the first two SC doses).
Appropriate antiplatelet therapy such as oral acetylsalicylic acid (75 mg to 325 mg once daily) should be administered concomitantly unless contraindicated. The recommended duration of treatment is 8 days or until hospital discharge, whichever comes first.
When administered in conjunction with a thrombolytic (fibrin specific or non-fibrin specific), enoxaparin sodium should be given between 15 minutes before and 30 minutes after the start of fibrinolytic therapy. o For dosage in patients ≥ 75 years of age, see paragraph “Elderly”.
o For patients managed with PCI, if the last dose of enoxaparin sodium SC was given less than 8 hours before balloon inflation, no additional dosing is needed. 3 mg/kg) enoxaparin sodium should be administered. Paediatric population The safety and efficacy of enoxaparin sodium in the […]
Within each system organ class, adverse reactions are presented in order of decreasing seriousness. 4).
Immune system disorders Common:
Allergic reaction Rare: Anaphylactic/Anaphylactoid reactions including shock* Nervous system disorders Common: Headache* Vascular disorders Rare: Spinal haematoma* (or neuraxial haematoma). 4).
Hepato-biliary disorders Very common:
Hepatic enzyme increases (mainly transaminases >3 times the upper limit of normality) Uncommon: Hepatocellular liver injury* Rare: Cholestatic liver injury* Skin and subcutaneous tissue disorders Common: Urticaria, pruritus, erythema Uncommon: Bullous dermatitis Rare: Alopecia, cutaneous vasculitis*, skin necrosis* usually occurring at the injection site (these phenomena have been usually preceded by purpura or erythematous plaques, infiltrated and painful).
Injection site nodules* (inflammatory nodules, which were not cystic enclosure of enoxaparin). They resolve after a few days and should not cause treatment discontinuation. 5). 2% of the patients (surgical patients). Some of these cases have been fatal.
In surgical patients, haemorrhage complications were considered major: (1) if the haemorrhage caused a significant clinical event, or (2) if accompanied by haemoglobin decrease ≥ 2 g/dL or transfusion of 2 or more units of blood products.
Retroperitoneal and intracranial haemorrhages were always considered major. 5). System Organ Class Prophylaxis in surgical patients Prophylaxis in medical patients Treatment in patients with DVT with or without PE Extended treatment of DVT and PE in patients with active cancer Treatment in patients with unstable angina and non-Q-wave MI Treatment in patients with acute STEMI Blood and lymphatic system disorders Very common: Haemorrhagea Rare: Retroperitone al haemorrhage Common: Haemorrhag ea Very common: Haemorrhagea Uncommon: Intracranial haemorrhage, Retroperitone al haemorrhage Commonb: Haemorrhage Common: Haemorrhagea Rare: Retroperitoneal haemorrhage Common: Haemorrhagea Uncommon: Intracranial haemorrhage, Retroperitoneal haemorrhage a: such as haematoma, ecchymosis other than at injection site, wound haematoma, haematuria, epistaxis and gastro-intestinal haemorrhage.
4 monitoring of platelet […]
The pre-filled disposable syringe is ready for immediate use.
SC injection technique:
Injection should be made preferably when the patient is lying down. Enoxaparin sodium is administered by deep SC injection. Do not expel the air bubble from the syringe before the injection to avoid the loss of drug when using pre-filled syringes.
When the quantity of drug to be injected requires to be adjusted based on the patient’s body weight, use the graduated pre-filled syringes to reach the required volume by discarding the excess before injection. Please be aware that in some cases it is not possible to achieve an exact dose due to the graduations on the syringe, and in such case the volume shall be rounded up to the nearest graduation.
The administration should be alternated between the left and right anterolateral or posterolateral abdominal wall. The whole length of the needle should be introduced vertically into a skin fold gently held between the thumb and index finger.
The skin fold should not be released until the injection is complete. Do not rub the injection site after administration. The safety system is triggered at the end of the injection. In case of self-administration, patient should be advised to follow instructions provided in the patient information leaflet included in the pack of this medicine.
IV (bolus) injection (for acute STEMI indication only):
For acute STEMI, treatment is to be initiated with a single IV bolus injection immediately followed by a SC injection. For IV injection, either the multidose vial or pre-filled syringe can be used. Enoxaparin sodium should be administered through an IV line.
It should not be mixed or co-administered with other medications. To avoid the possible mixture of enoxaparin sodium with other drugs, the IV access chosen should be flushed with a sufficient amount of saline or dextrose solution prior to and following the IV bolus administration of enoxaparin sodium to clear the port of drug.
9%) or 5% dextrose in water. • Initial 3,000 IU (30 mg) bolus: For the initial 3,000 IU (30 mg) bolus, using an enoxaparin sodium graduated pre-filled syringe, expel the excessive volume to retain only 3,000 IU (30 mg) in the syringe.
The 3,000 IU (30 mg) dose can then be directly injected into the IV line. 3 mg/kg) is to be administered if last SC administration was given more than 8 hours before balloon inflation. In order to assure the accuracy of the small volume to be injected, it is recommended to dilute the drug to 300 IU/ml (3 mg/ml).
e. 9%) or 5% dextrose in water) as follows: • Withdraw 30 ml from the infusion bag with a syringe and discard the liquid. Inject the complete contents of the 6,000 IU (60 mg) enoxaparin sodium pre- filled syringe into the 20 ml remaining in the bag.
Gently mix the contents of the bag. Withdraw the required volume of diluted solution with a syringe for administration into the IV line. 1] or using the table below. It is recommended to prepare the dilution immediately before use. Volume to be injected through IV line after dilution is completed at a concentration of 300 IU (3 mg)/ml.
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