Cardinex 60 | 6000 Anti-Xa IU/0.6 ml | ePharma
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Home Medicines Blood Clot Cardinex 60mg/0.6ml Injection
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Cardinex 60mg/0.6ml Injection

Generic: Enoxaparin Sodium

Type: Injection

Pack Size: 1 Pc

Cardinex 60mg/0.6ml Injection

  1. Myocardial infarction (MI):
    • For the management of acute myocardial infarction (AMI).
  2. Unstable angina:
    • Used to reduce the risk of ischemic complications in unstable angina.
  3. Venous thromboembolism (VTE):
    • Prophylaxis and treatment of venous thromboembolism.
  4. Deep vein thrombosis (DVT):
    • Prevention and treatment of deep vein thrombosis that may lead to pulmonary embolism (PE).

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MRP: ৳ 572 5% Off

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✅ Description:

  1. Avoid intramuscular administration due to the risk of hematoma formation.
  2. Carefully monitor patients with low body weight for bleeding risk, as they may be more susceptible to adverse effects.
  3. If used during IV therapy, ensure proper dilution and compatibility of the carrier solution.
Pack Image of Cardinex 6000 Anti-Xa Injection

Relevant Products / প্রাসঙ্গিক পণ্য

✔️ Mechanism of Action:
  • Enoxaparin enhances the activity of antithrombin III, which inhibits clotting factors such as thrombin (factor IIa) and activated factor Xa (factor Xa).
  • This results in an anticoagulant effect, reducing the risk of thrombus formation.
✔️ Administration

Subcutaneous (SC) Injection:

  • Administer deep SC injections into the right or left anterior and posterior abdominal walls. Alternate injection sites between sides.
  • Pinch a fold of skin between the thumb and forefinger to form a skin fold for injection.
  • Do not rub the site after injection to avoid bruising.

Low body weight considerations:

  • Women: <45 kg.
  • Men: <57 kg.
  • These patients may experience increased exposure to the medication with non-weight-adjusted prophylactic doses. Careful monitoring for signs or symptoms of bleeding is necessary.

For IV Administration:

  • May administered in an IV line using 0.9% sodium chloride (NaCl) or 5% dextrose (D5W) as the carrier solution.

Measurement of dose:

  • Use a tuberculin syringe (or equivalent) to ensure precise dose measurement if adjustments are required.
✔️ Adult Dosing for Enoxaparin Sodium (Cardinex)

1. Deep Vein Thrombosis (DVT) Prophylaxis

  • To prevent pulmonary embolism (PE) and thromboembolic complications in patients undergoing surgery or with restricted mobility.

Abdominal Surgery

  • Dose: 40 mg SC once daily.
  • Timing: Initiate 2 hours preoperatively.
  • Duration: Administer for 7-10 days, or up to 12 days, until the DVT risk is diminished.

Knee or Hip Replacement Surgery

Option 1:

  • Dose: 30 mg SC every 12 hours.
  • Timing: Start 12–24 hours postoperatively.
  • Duration: Continue for 10 days to 35 days or until the DVT risk is reduced.

Option 2 (for hip replacement):

  • Dose: 40 mg SC once daily.
  • Timing: Initiate 9–15 hours preoperatively.
  • Duration: Continue for 10 days to 35 days.

Medical Patients with Restricted Mobility

  • Dose: 40 mg SC once daily.
  • Duration: Administer for 6–11 days, or up to 14 days, until DVT risk diminishes.

2. Deep Vein Thrombosis (DVT) Treatment

Inpatient (With or Without Pulmonary Embolism)

  • Dose Options:
  • 1 mg/kg SC every 12 hours, OR
  • 1.5 mg/kg SC once daily.

Outpatient (Without Pulmonary Embolism)

  • Dose: 1 mg/kg SC every 12 hours.

Considerations:

  • Initiate warfarin therapy within 72 hours of starting enoxaparin.
  • Continue enoxaparin for at least 5 days and until the INR is between 2.0–3.0.
  • Typical duration is 7 days, but up to 17 days has been used in trials.

3. Unstable Angina & Non-Q-Wave Myocardial Infarction (MI)

  • Dose: 1 mg/kg SC every 12 hours.
  • Concomitant Therapy: Administer with aspirin (100–325 mg/day PO).
  • Duration: Treat for 2–8 days; up to 12.5 days in trials.

4. Acute STEMI (ST-Elevation Myocardial Infarction)

Patients <75 Years Old

  • Loading Dose: 30 mg IV bolus plus 1 mg/kg SC once (max 100 mg cumulative loading dose).
  • Maintenance Dose: 1 mg/kg SC every 12 hours.

Patients ≥75 Years Old

  • No IV bolus.
  • Dose: 0.75 mg/kg SC every 12 hours (max 75 mg/dose for the first two doses).

PCI (Percutaneous Coronary Intervention)

  • If Last Dose <8 Hours Ago: No additional dosing.
  • If Last Dose 8–12 Hours Ago: 0.3 mg/kg IV bolus.
  • If Last Dose >12 Hours Ago: Use alternative anticoagulation (e.g., unfractionated heparin or full-dose LMWH).

Concomitant Therapy

  • Administer with aspirin (75–325 mg/day) and a thrombolytic agent, if appropriate.

Duration

  • The optimal duration is 8 days or until hospital discharge, whichever comes first.
✔️ Dosing Considerations: Enoxaparin Sodium
  • Renal Impairment: Adjust dose for patients with creatinine clearance <30 mL/min:
    • Prophylaxis: 20 mg SC once daily.
    • Treatment: 1 mg/kg SC once daily.
  • Elderly: No adjustments unless kidney function is impaired.
  • Hepatic Impairment: Use caution due to increased bleeding risk.
✔️ Renal Dosing Adjustments for Enoxaparin Sodium (Cardinex)

Severe Renal Impairment (CrCl <30 mL/min)

Prophylaxis:

  • Abdominal Surgery: 30 mg SC once daily.
  • Hip or Knee Replacement Surgery: 30 mg SC once daily.
  • Medical Patients with Restricted Mobility: 30 mg SC once daily.

Deep Vein Thrombosis (DVT) Treatment:

  • Inpatient or Outpatient (with warfarin): 1 mg/kg SC once daily.

Non-Q-Wave Myocardial Infarction (MI):

  • 1 mg/kg SC once daily.

Acute STEMI:

  • For Patients <75 Years:
    • Loading Dose: 30 mg IV single bolus + 1 mg/kg SC.
    • Maintenance Dose: 1 mg/kg SC once daily.
  • For Patients ≥75 Years:
    • No initial IV bolus.
    • Maintenance Dose: 1 mg/kg SC once daily.
✔️ Side Effects of Enoxaparin Sodium (Cardinex)

Common Side Effects

  • Bleeding (Hemorrhage): Increased risk of bleeding at various sites, including gastrointestinal or surgical wounds.
  • Thrombocytopenia: Low platelet count, potentially leading to increased bleeding risk.
  • Elevations of Serum Aminotransferase: Temporary increases in liver enzymes (ALT/AST), usually asymptomatic.

Localized Reactions

  • Pain at Injection Sites: Mild to moderate discomfort or tenderness.
  • Bruising (Bluish Marks): This may occur at injection sites due to small blood vessel trauma.
  • Skin Rash: Allergic or localized reactions, including redness and irritation at the site of administration.

Serious Side Effects

  • Neuraxial Hematomas:
    • Observed with concurrent use of enoxaparin and spinal/epidural anesthesia or during a spinal puncture.
    • May result in neurologic injuries of varying degrees, including paralysis.
    • Requires close monitoring for signs of spinal cord compression (e.g., back pain, weakness, sensory changes).
✔️ Contraindications for Enoxaparin Sodium

Hypersensitivity:

  • Known hypersensitivity to Enoxaparin, heparin, or other low molecular weight heparins.

Active Bleeding Disorders:

  • History of thrombocytopenia.
  • Active gastrointestinal ulcers or organic lesions are likely to bleed.

Recent Hemorrhagic Stroke:

  • Recent vascular cerebral hemorrhagic stroke.

Allergic Reactions:

  • Rare but possible cutaneous or systemic allergic reactions.
✔️ Precautions and Warnings
  • Do not administer intramuscularly (IM). Enoxaparin is designed for subcutaneous (SC) or intravenous (IV) use.

Exercise caution in patients with the following conditions:

  • Impaired hemostasis.
  • History of peptic ulcers (may increase the risk of gastrointestinal bleeding).
  • Recent ischemic stroke (cerebral bleeding risk).
  • Uncontrolled severe arterial hypertension.
  • Diabetic retinopathy (increased bleeding risk in fragile vascular tissues).
  • Recent neurosurgery or ophthalmologic surgery (higher risk of localized bleeding).
  • Low body weight patients (higher exposure to the drug, increasing bleeding risk).

Platelet Monitoring:

  • Platelet counts should be measured prior to treatment initiation and monitored regularly during therapy to detect potential thrombocytopenia.

Lactation:

  • Unknown whether enoxaparin is excreted in breast milk.
  • Not recommended during breastfeeding due to the potential for adverse effects on nursing infants.
✔️ Pregnancy and Lactation Considerations for Enoxaparin Sodium

Pregnancy

Category: Not formally classified under the FDA's previous categories, but data suggest minimal risk.

Human Data:

  • A retrospective cohort study found no increased risk of major developmental abnormalities in pregnancies exposed to enoxaparin.
  • Pregnancy itself increases the risk of thromboembolism, especially in women with:
    • Thromboembolic disease.
    • Mechanical prosthetic heart valves.
    • Inherited or acquired thrombophilias.

High-Risk Pregnancies:

  • Women with these conditions are at a greater risk of maternal complications and fetal loss, regardless of the anticoagulant used.
  • Pregnant women with mechanical prosthetic heart valves are particularly vulnerable to thrombosis and require heightened monitoring.

Bleeding Risks:

  • All patients on anticoagulants, including pregnant women, are at risk for bleeding complications.
  • Bleeding can occur at any site, potentially leading to maternal and/or fetal death.
  • Close monitoring for bleeding or excessive anticoagulation is necessary during therapy.

Counseling:

  • Pregnant women should be informed of the potential risks to both the mother and fetus if enoxaparin is used during pregnancy.

Lactation

Excretion in Human Milk:

  • Unknown if enoxaparin or its metabolites are excreted in human breast milk.
  • Studies in lactating rats show minimal passage of enoxaparin or its metabolites into milk.

Considerations:

  • The benefits of breastfeeding for the infant should be weighed against:
    • The mother’s clinical need for enoxaparin.
    • The potential for adverse effects on the infant.

Recommendation:

  • As a precaution, breastfeeding is not recommended during enoxaparin therapy due to the lack of data on potential adverse effects on the breastfed child or milk production.
✔️ Drug Interaction Information for Enoxaparin Sodium

Concurrent use with other anticoagulants (e.g., warfarin, and heparin) significantly increases the risk of bleeding.

Platelet Aggregation Inhibitors:

  • Examples: Dipyridamole, clopidogrel, ticlopidine, glycoprotein IIb/IIIa inhibitors.
  • These agents impair platelet function, further increasing bleeding risk.

Salicylates and NSAIDs:

  • Includes acetylsalicylic acid (aspirin) and other nonsteroidal anti-inflammatory drugs.
  • Both classes can exacerbate gastrointestinal bleeding or inhibit platelet aggregation, heightening the risk.

Sulfinpyrazone:

  • May potentiate bleeding tendencies when combined with enoxaparin.

Vitamin E

  • Vitamin E may enhance bleeding risk due to its potential anticoagulant effects. Use with care when combined with enoxaparin, especially in high doses.
✔️ Storage:

Store in a cool and dry place, protect from light and moisture. Do not store above 25°C. Do not store in a refrigerator or freezer. Keep out of the reach of children

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