Enoxaparin STADA Drug Interactions

Certain drugs or therapeutic classes may promote the occurrence of hyperkalemia: potassium salts, potassium-sparing diuretics, conversion enzyme inhibitors, angiotensin II inhibitors, non-steroidal anti-inflammatory drugs, heparins (low-molecular-weight or unfractionated heparin), ciclosporin and tacrolimus, trimethoprim.
Occurrence of hyperkalemia may depend on possible related risk factors. This risk is potentiated when the previously mentioned drugs are co-administered.
It is recommended that agents which affect hemostasis should be discontinued prior to enoxaparin therapy unless strictly indicated. These agents include medications such as: Systemic salicylates, acetylsalicylic acid, and NSAIDs including ketorolac; Dextran 40, ticlopidine and clopidogrel; Systemic glucocorticoids; Thrombolytic and anticoagulants; Other anti-platelet agents including glycoprotein IIb/IIIa antagonists.
If the combination is indicated, enoxaparin sodium should be used with careful clinical and laboratory monitoring when appropriate.
Preventive forms (Elderly patients-over 65 years of age) & curative forms: Inadvisable combinations: Acetylsalicylic acid at analgesic, antipyretic and anti-inflammatory doses (and, by extrapolation, other salicylates): Increased risk of bleeding (salicylate-induced platelet function inhibition and gastroduodenal mucosal damage).
Use a non-salicylate antipyretic analgesic (such as paracetamol).
NSAIDs (systemic use): Increased risk of bleeding (NSAID-induced platelet function inhibition and gastroduodenal mucosal damage).
If co-administration cannot be avoided, close clinical monitoring is required.
Dextran 40 (parenteral use): Increased risk of bleeding (inhibition of platelet function by dextran 40).
Combinations requiring precautions for use: Oral anticoagulants: Potentiation of the anticoagulant effect.
When heparin is replaced by an oral anticoagulant, clinical monitoring must be intensified.
Combinations to take into consideration: Platelet aggregation inhibitors (other than acetylsalicylic acid at analgesic, anti-pyretic and anti-inflammatory doses; NSAIDs): abciximab, acetylsalicylic acid at antiaggregant doses in cardiological and neurological indications, beraprost, clopidogrel, eptifibatide, iloprost, ticlopidine, tirofiban. Increased risk of bleeding.
Preventive forms (Patients under 65 years of age): Combinations to take into consideration: Combined use of drugs which variably affect hemostasis potentiate the risk of bleeding. Therefore, regardless of the age of the patients, co-administration of LMWH at preventive doses with the following drugs must be taken into consideration by means of continued clinical monitoring and possible laboratory tests: oral anticoagulants, platelet aggregation inhibitors (abciximab, NSAIDS, acetylsalicylic acid at any dose, clopidogrel, eptifibatide, iloprost, ticlopidine, tirofiban) and thrombolytic agents.