Last update Aug. 29, 2021

Enoxaparin Sodium

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Low-molecular-weight heparin.
Indicated in the treatment and prevention of arterial, venous or pulmonary thromboembolism and in acute coronary syndrome.
Authorized use in neonates and infants.
Subcutaneous administration.

Absence of anticoagulant activity in plasma of infants breastfed by mothers treated with enoxaparin has been reported (Guillonneau 1996).
No problems have been observed in infants of mothers treated with enoxaparin (Ylikotila 2015, Guillonneau 1996).

The high molecular weight of standard or unfractionated heparin and also of the so-called low molecular weight heparins makes it very unlikely that they will pass into breast milk in a clinically significant amount.
There is virtually no excretion in breast milk of another low molecular weight heparin, dalteparin (Richter 2001).

In addition, heparins are inactivated in the gastrointestinal tract, not being absorbed (practically zero oral bioavailability), which prevents the passage into plasma of the infant from ingested breast milk (Sanofi 2020, AEMPS 2020).

The risk of heparin-induced thrombocytopenia and osteoporosis is lower with low molecular weight heparins (Fuller 2013, Middeldorp 2011, Rath 2010).

The manufacturer, various medical societies, experts and expert consensus consider the use of this medication safe during breastfeeding (Hale, Lactmed, Sanofi 2020, AEMPS 2020, Bates 2018 and 1997, Noviani 2016, Briggs 2015, Schaefer 2015, Fuller 2013, Yurdakök 2012, Rath 2010).

Alternatives

  • Acenocoumarol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Dalteparin Sodium ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Warfarin ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Enoxaparin Sodium in other languages or writings:

Group

Enoxaparin Sodium belongs to this group or family:

Tradenames

Main tradenames from several countries containing Enoxaparin Sodium in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 0 %
Molecular weight 4.500 (3.800 - 5.000) daltons
VD 0.07 l/Kg
Tmax 3 - 5 hours
4 - 7 hours

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Azenkot T, Schwarz EB. Special Considerations for Women of Reproductive Age on Anticoagulation. J Gen Intern Med. 2022 Aug;37(11):2803-2810. Abstract Full text (link to original source)
  4. AEMPS. Enoxaparina. Ficha técnica. 2020 Full text (in our servers)
  5. Sucker C. Prophylaxis and Therapy of Venous Thrombotic Events (VTE) in Pregnancy and the Postpartum Period. Geburtshilfe Frauenheilkd. 2020 Jan;80(1):48-59. Abstract Full text (link to original source)
  6. Sanofi. Enoxaparin (Clexane). Drug Summary. 2020 Full text (in our servers)
  7. Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, Vazquez SR, Greer IA, Riva JJ, Bhatt M, Schwab N, Barrett D, LaHaye A, Rochwerg B. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-3359. Abstract Full text (link to original source)
  8. Noviani M, Wasserman S, Clowse ME. Breastfeeding in mothers with systemic lupus erythematosus. Lupus. 2016 Aug;25(9):973-9. Abstract
  9. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  10. Ylikotila P, Ketola RA, Timonen S, Malm H, Ruuskanen JO. Early pregnancy cerebral venous thrombosis and status epilepticus treated with levetiracetam and lacosamide throughout pregnancy. Reprod Toxicol. 2015 Nov;57:204-6. Abstract
  11. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, Third Edition. 2015
  12. Fuller KP, Turner G, Polavarapu S, Prabulos AM. Guidelines for use of anticoagulation in pregnancy. Clin Lab Med. 2013 Abstract
  13. Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012 Abstract
  14. Middeldorp S. How I treat pregnancy-related venous thromboembolism. Blood. 2011 Abstract Full text (link to original source) Full text (in our servers)
  15. Rath W. [Thromboprophylaxis during pregnancy and the puerperium: highlights from current guidelines]. Z Geburtshilfe Neonatol. 2010 Abstract
  16. Richter C, Sitzmann J, Lang P, Weitzel H, Huch A, Huch R. Excretion of low molecular weight heparin in human milk. Br J Clin Pharmacol. 2001 Abstract Full text (link to original source) Full text (in our servers)
  17. Bates SM, Ginsberg JS. Anticoagulants in pregnancy: fetal effects. Baillieres Clin Obstet Gynaecol. 1997 Abstract
  18. Guillonneau M, de Crepy A, Aufrant C, Hurtaud-Roux MF, Jacqz-Aigrain E. [Breast-feeding is possible in case of maternal treatment with enoxaparin]. Arch Pediatr. 1996 Abstract
  19. Kandrotas RJ. Heparin pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 1992 Abstract
  20. Estes JW. Clinical pharmacokinetics of heparin. Clin Pharmacokinet. 1980 Abstract

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