Clexane (Enoxaparin Sodium)
Also sold as: Clexane, Lovenox, Enox, Enclex, Neoparin
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Pre-filled syringe SC: 20mg/0.2mL, 40mg/0.4mL, 60mg/0.6mL, 80mg/0.8mL, 100mg/1mL +1
Indications
- DVT treatment and PE
- DVT/VTE prophylaxis (surgical and medical)
- ACS — NSTEMI / STEMI (as part of PCI protocol)
- Anticoagulation in pregnancy (instead of warfarin/DOACs)
- Bridging therapy for warfarin procedures
- Heparin-based anticoagulation in dialysis (circuit)
Adult Dosing
DVT/PE treatment
1 mg/kg SC BD OR 1.5 mg/kg SC OD
5-10 days; overlap with warfarin or DOAC
VTE prophylaxis (high-risk surgical)
40 mg SC once daily
Start 12 hours pre-op or 12 hours post-op; continue until ambulatory
VTE prophylaxis (medical)
40 mg SC once daily
6-14 days in hospital
ACS (NSTEMI)
1 mg/kg SC BD
With aspirin. Reduce to 1 mg/kg OD if CrCl < 30 mL/min.
Pediatric Dosing
TDM mandatory in all paediatric patients. Anti-Xa target: treatment 0.5-1 IU/mL; prophylaxis 0.2-0.4 IU/mL.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 30 mL/min | Standard dosing |
| CrCl < 30 mL/min | Prophylaxis: 20 mg OD. Treatment: 1 mg/kg OD (not BD). ACS: 1 mg/kg OD. Monitor anti-Xa. |
Hepatic Adjustment
No specific adjustment; use cautiously — hepatic metabolism minimal
Pregnancy & Lactation
Pregnancy: Category B
PREFERRED anticoagulant in pregnancy — does not cross placenta. Use throughout pregnancy for maternal VTE treatment or prevention. Adjust dose for weight gain. Switch timing around delivery — stop 24 hours before planned delivery.
Lactation: Safe
Not absorbed orally; negligible breast milk excretion. Safe during breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| NSAIDs / Aspirin / Clopidogrel / Other anticoagulants | Increased bleeding risk | Major |
| Glycoprotein IIb/IIIa inhibitors | Additive bleeding — use cautiously in PCI | Major |
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Side Effects
Common
- Injection site bruising / haematoma (very common)
- Pain at injection site
- Elevated LFTs (transient)
- Thrombocytopenia (mild, type I)
Serious / Discontinue If
- Heparin-induced thrombocytopenia type II (HIT) — paradoxical thrombosis (day 5-14; less common than UFH)
- Major bleeding
- Spinal/epidural haematoma (with neuraxial anaesthesia)
- Hyperkalaemia (aldosterone suppression, long-term)
- Osteoporosis (prolonged use)
Contraindications
- Active major bleeding
- HIT type II history (use fondaparinux instead)
- Prosthetic heart valves (use UFH)
- Severe thrombocytopaenia
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Clexane 40mg | Sanofi | Syringe ₹285 |
| Enox 40mg | Cipla | Syringe ₹185 |
| Enclex 40mg | Emcure | Syringe ₹165 |
| Neoparin 40mg | Neon Labs | Syringe ₹155 |
Monitoring Required
- Platelet count (baseline, day 5-10 — HIT watch)
- Anti-Xa levels (renal impairment, pregnancy, extremes of weight: target 0.5-1 IU/mL therapeutic 4 hours post-dose)
- Renal function (creatinine)
- Signs of bleeding
- Potassium (long-term)
Patient Counseling Points
- SC injection technique: pinch abdominal skin, insert needle 90°, inject slowly — do NOT expel air bubble before injection (for pre-filled syringes)
- Rotate injection sites (alternate sides of abdomen, 2 inches from navel)
- Bruising at injection site is normal — apply gentle pressure after
- Report: unusual swelling, chest pain, blood in urine/stool
- In pregnancy: important not to miss doses — discuss timing with obstetrician near delivery
Stop Googling drug references mid-consultation
EasyClinic auto-flags Clexane interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Priya Sharma, DM (Cardiology), Senior Cardiologist
Last reviewed: 2026-04-01
References
- BNF — Enoxaparin
- ESC VTE Guidelines 2019
- RCOG VTE in Pregnancy Guidelines
- ACCP Antithrombotic Guidelines 2021