Enoxaparin Dosing

[Pharmacy Kid]

How often do you see enoxaparin 1.5mg/kg QDAY in the outpatient setting?

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[WVUPharm2007]

The rare morbidly obese person who I assume is getting it for prophylaxis. I don't think I've given it out as an outpatient treatment dose, though. But I don't know for sure, its not like they tell us the diagnosis for anything, ever.

 

[Carboxide]

All the time. It's equally effective and is only one poke a day. I regularly recommend it over 1 mg/kg BID.

 

[Digsbe]

I've mainly seen it on the hospital side of things, but I've seen it done 1.5 mg/kg once daily very frequently. I've actually put patients on that (under supervision of course) and think for most people it's better than 1 mg/kg BID.

 

[bacillus1]

All the time. It's equally effective and is only one poke a day. I regularly recommend it over 1 mg/kg BID.

If you read the CHEST guidelines closely, enoxaparin BID is recommended over once daily for VTE treatment. For other indications, once daily may be OK.

 

[Carboxide]

If you read the CHEST guidelines closely, enoxaparin BID is recommended over once daily for VTE treatment. For other indications, once daily may be OK.

What level did they give the recommendation?

 

[Dred Pirate]

The rare morbidly obese person who I assume is getting it for prophylaxis. I don't think I've given it out as an outpatient treatment dose, though. But I don't know for sure, its not like they tell us the diagnosis for anything, ever.

wrong wrong wrong

prophy is 40 daily or 40 bid for obese (there are other alternatives)

1.5mg/kg day is treatment dose as an alternative to 1 mg/kg bid

I don't say this to be mean, but don't you learn these things in school?? This is the basic minimum competency for all of my students that go through me.

 

[WVUPharm2007]

wrong wrong wrong

prophy is 40 daily or 40 bid for obese (there are other alternatives)

1.5mg/kg day is treatment dose as an alternative to 1 mg/kg bid

I don't say this to be mean, but don't you learn these things in school?? This is the basic minimum competency for all of my students that go through me.

Pfft. Actually I did know that...I actually helped write my old hospital's enoxaparin dosing in obese patients protocol back in 2009 when those concerns first started emerging. I posted that in a jet lagged haze after getting home from Iceland. Jesus, that's embarrassing. Oh well. I lose internet points.

On the bright side, I got to eat Icelandic lamb and hot dogs, so I got that going for me.

 

[rxlea]

Pfft. Actually I did know that...I actually helped write my old hospital's enoxaparin dosing in obese patients protocol back in 2009 when those concerns first started emerging. I posted that in a jet lagged haze after getting home from Iceland. Jesus, that's embarrassing. Oh well. I lose internet points.

On the bright side, I got to eat Icelandic lamb and hot dogs, so I got that going for me.

Please tell us more about the food.

 

[Dred Pirate]

Pfft. Actually I did know that...I actually helped write my old hospital's enoxaparin dosing in obese patients protocol back in 2009 when those concerns first started emerging. I posted that in a jet lagged haze after getting home from Iceland. Jesus, that's embarrassing. Oh well. I lose internet points.

On the bright side, I got to eat Icelandic lamb and hot dogs, so I got that going for me.

Ok. I will give you a pass then 🙂 ! I was gonna feel like a had ass because that is one question I ask my students every day until they have it down pat.

 

[farmadiazepine]

wrong wrong wrong

prophy is 40 daily or 40 bid for obese (there are other alternatives)

1.5mg/kg day is treatment dose as an alternative to 1 mg/kg bid

I don't say this to be mean, but don't you learn these things in school?? This is the basic minimum competency for all of my students that go through me.

I totally respect you, but I am going to counter the last thing you said. No, we don't learn these things in school. We are taught Lovenox dosing and we know how to spit it back to pick the correct answer on the test. In terms of practical, real world application, no we don't learn it. I graduated in 2011, top of my class. I knew Lovenox dosing for the test, and that was it. I worked retail for my entire working career until now, when I recently started at a hospital. I learned about Lovenox dosing in the hospital, from my colleagues.

You learn real world pharmacy application from work experience. If you don't do it, you won't learn it. A hospital pharmacist doesn't know anything about basic retail pharmacy until they work in a retail pharmacy. A student doesn't know anything because they don't have any experience. Even a recent Pharm.D. graduate doesn't know anything because they don't have real world experience, and no, rotations are not real experience. They are a primer, more of an exposure to what's going on. A retail pharmacist doesn't know anything about hospital pharmacy until they work in one. Outpatient Lovenox dosing, no pharmacist checks it, instead we usually dispense whats written.

 

[sakigt]

Once. The doc said the hem/onc doc wanted it. *shrug*

Oh yeah, and for some reason I happened to notice the script the ER doc wrote was 1.5mg/kg bid. Dat ER pharmacist tho.....

 

[Dred Pirate]

I totally respect you, but I am going to counter the last thing you said. No, we don't learn these things in school. We are taught Lovenox dosing and we know how to spit it back to pick the correct answer on the test. In terms of practical, real world application, no we don't learn it. I graduated in 2011, top of my class. I knew Lovenox dosing for the test, and that was it. I worked retail for my entire working career until now, when I recently started at a hospital. I learned about Lovenox dosing in the hospital, from my colleagues.

You learn real world pharmacy application from work experience. If you don't do it, you won't learn it. A hospital pharmacist doesn't know anything about basic retail pharmacy until they work in a retail pharmacy. A student doesn't know anything because they don't have any experience. Even a recent Pharm.D. graduate doesn't know anything because they don't have real world experience, and no, rotations are not real experience. They are a primer, more of an exposure to what's going on. A retail pharmacist doesn't know anything about hospital pharmacy until they work in one. Outpatient Lovenox dosing, no pharmacist checks it, instead we usually dispense whats written.

I get what you are saying - I meant no disrespect - we all have our "specialties" that we take for granted. I have forgotten a heck of a lot in 10 years. Although I do question why someone in retail, if they were not familiar with a dose - especially of a high risk drug, would just fill it without verifying that it made sense.

 

[Dred Pirate]

Once. The doc said the hem/onc doc wanted it. *shrug*

Oh yeah, and for some reason I happened to notice the script the ER doc wrote was 1.5mg/kg bid. Dat ER pharmacist tho.....

You gotta love radio buttons on e scribe - I can almost guarantee you that is how that mistake happened

 

[zelman]

. Although I do question why someone in retail, if they were not familiar with a dose - especially of a high risk drug, would just fill it without verifying that it made sense.

Because lovenox dosing can't make sense without knowing the dose, indication, patient weight and renal function. We know 25% of the requisite data and have about 45 seconds to spend on this prescription.

 

[confettiflyer]

BID dosing for my inpatients 99.999% of the time primarily for indication purposes as discussed by bacillus1, I see 1.5 mg/kg once in a blue moon, so our discharge to outpt usually matches.

I also think, psychologically, "lower dose, more frequent" makes prescribers feel better wrt anticoagulation and holding for procedures. Just a hunch, though.

 

[PharmDBro2017]

wrong wrong wrong

prophy is 40 daily or 40 bid for obese (there are other alternatives)

1.5mg/kg day is treatment dose as an alternative to 1 mg/kg bid

I don't say this to be mean, but don't you learn these things in school?? This is the basic minimum competency for all of my students that go through me.

Got to agree with you, particular teachers (the good ones) hammer us on lovenox dosing whenever the opportunity arises.

For (prophylaxis dosing) renal impairment, CrCl <30ml/min = 30mg/kg QD, right?

 

[zelman]

For (prophylaxis dosing) renal impairment, CrCl <30ml/min = 30mg/kg QD, right?

No. Just 30mg QD. No weight based dosing.

Got to agree with you, particular teachers (the good ones) hammer us on lovenox dosing whenever the opportunity arises.

...maybe it still wasn't enough...

 

[Dred Pirate]

Because lovenox dosing can't make sense without knowing the dose, indication, patient weight and renal function. We know 25% of the requisite data and have about 45 seconds to spend on this prescription.

and this is one of the major issues our profession has - having to force things through so fast. Any patient that leaves our hospital on lovenox gets pharmacist education -

 

[Wheresmyaricept]

I get what you are saying - I meant no disrespect - we all have our "specialties" that we take for granted. I have forgotten a heck of a lot in 10 years. Although I do question why someone in retail, if they were not familiar with a dose - especially of a high risk drug, would just fill it without verifying that it made sense.

Someone hasn't worked retail in a while. You would spend half your day calling doctors and not actually dispensing anything. Would you catch a hell of a lot more errors? Probably. Would your DM crack down on you for poor metrics? Yep.

Pick your battles in retail! If something is blatantly wrong then yes by all means go for it. Lovenox outpatient scripts are pretty uncommon. Maybe a few scripts a day, for a few days supply at most. Counsel patient on signs of bleeding and when to seek medical attention and move on.