Lupinox inj
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Lupinox is a brand name for Enoxaparin sodium injection - a low molecular weight heparin (LMWH) used as an anticoagulant. Let me search the medical library and web for comprehensive details.
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Lupinox injection enoxaparin sodium uses dosage
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Lupinox Injection (Enoxaparin Sodium)
Lupinox is Lupin Pharmaceuticals' brand of enoxaparin sodium - a Low Molecular Weight Heparin (LMWH) used as a parenteral anticoagulant.
Drug Class & Mechanism
Enoxaparin is produced by cleaving unfractionated heparin (UFH) into shorter fragments (mean molecular weight ~4,000 Da, ~15 saccharide units). It acts via antithrombin (AT) to selectively inhibit Factor Xa (and partially Factor IIa/thrombin). Compared to UFH:
- More specific and predictable anticoagulation
- Longer half-life - allows once or twice daily SC dosing
- Does NOT usually require routine laboratory monitoring (aPTT not affected)
- Anti-Factor Xa levels may be needed in renal failure, pregnancy, extremes of body weight (<50 kg or >80 kg)
(Miller's Anesthesia, 10e; Fuster & Hurst's The Heart, 15e)
Available Strengths
| Concentration | Presentations |
|---|---|
| 100 mg/mL | 20 mg/0.2 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL prefilled syringes |
| 150 mg/mL | 120 mg/0.8 mL, 150 mg/1 mL prefilled syringes |
| Multidose vial | 300 mg/3 mL (contains benzyl alcohol as preservative) |
Lupinox is available in India typically as 20 mg, 40 mg, 60 mg, 80 mg prefilled syringes.
Indications & Dosing
| Indication | Dose |
|---|---|
| DVT prophylaxis - abdominal surgery | 40 mg SC once daily (start 2 hrs pre-op), 7-10 days |
| DVT prophylaxis - hip/knee replacement | 30 mg SC every 12 hrs OR 40 mg SC once daily, up to 14 days |
| DVT prophylaxis - medical/acutely ill | 40 mg SC once daily, 6-14 days |
| Treatment of DVT ± PE (inpatient) | 1 mg/kg SC every 12 hrs OR 1.5 mg/kg SC once daily |
| Treatment of DVT without PE (outpatient) | 1 mg/kg SC every 12 hrs |
| Unstable angina / NSTEMI | 1 mg/kg SC every 12 hrs + aspirin, 2-8 days |
| STEMI (with fibrinolysis, age <75) | 30 mg IV bolus + 1 mg/kg SC every 12 hrs |
| STEMI (age ≥75) | 0.75 mg/kg SC every 12 hrs (no IV bolus) |
Pharmacokinetics
- Route: Subcutaneous (SC); IV bolus for STEMI
- Bioavailability: ~100% after SC injection
- Half-life: ~4.5 hours (longer than UFH)
- Excretion: Primarily renal - dose adjustment needed in CrCl <30 mL/min
Renal impairment dose (CrCl <30 mL/min):
- All prophylaxis indications: 30 mg SC once daily
- Treatment of DVT/PE: 1 mg/kg SC once daily
Contraindications
- Active major bleeding
- History of immune-mediated heparin-induced thrombocytopenia (HIT) within past 100 days or with circulating antibodies
- Hypersensitivity to enoxaparin, heparin, or pork products
- Hypersensitivity to benzyl alcohol (multidose vials)
Key Warnings & Precautions
- Spinal/epidural hematoma: Risk increases with neuraxial anesthesia, spinal puncture, indwelling epidural catheters - can cause permanent paralysis
- Hemorrhage: Monitor for bleeding; avoid in uncontrolled bleeding
- Thrombocytopenia: Monitor platelet counts; discontinue if significant drop
- Pregnancy: Use with caution; not recommended with mechanical prosthetic heart valves (risk of valve thrombosis)
- Obese patients: Use actual body weight for dosing
Reversal
Protamine sulfate partially reverses enoxaparin:
- 1 mg protamine neutralizes ~1 mg enoxaparin
- Only partially effective - protamine neutralizes the higher MW fractions (those with ≥14 saccharide units) but does NOT completely abolish anti-Xa activity
- Give protamine within 8 hours of last enoxaparin dose
(The Harriet Lane Handbook, 23e; Miller's Anesthesia, 10e)
Drug Interactions
- NSAIDs, aspirin, clopidogrel, other anticoagulants: Additive bleeding risk
- Thrombolytics: Increased hemorrhage risk
- SSRIs: Mild increased bleeding risk
Monitoring
Routine aPTT monitoring is not required. Anti-Factor Xa levels should be checked in:
- Renal impairment
- Pregnancy
- Extremes of body weight
- Patients not responding as expected
Target anti-Xa level (therapeutic): 0.5-1.0 IU/mL (BID dosing), 1.0-2.0 IU/mL (once daily dosing)
Clinical Evidence
Clinical trials (ESSENCE, ExTRACT-TIMI 25) have shown enoxaparin produces a 15-20% reduction in death or MI at 4-6 weeks versus UFH in NSTE-ACS managed medically, with a small excess in minor bleeding. For STEMI patients receiving fibrinolysis, enoxaparin vs UFH trials showed improved outcomes. (Fuster & Hurst's The Heart, 15e)
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