Cardinex 40mg/0.4ml Injection

✔️ Cardinex is used for:

1. Treating deep vein thrombosis (DVT), with or without pulmonary embolism.
2. Managing unstable angina and non-Q-wave myocardial infarction when combined with aspirin.
3. Preventing thrombus formation during hemodialysis.
4. Prophylaxis of venous thromboembolism (VTE) in:
   • Orthopedic or general surgery.
   • Bedridden medical patients with acute illnesses (e.g., cardiac insufficiency, respiratory failure, severe infections, rheumatic diseases).

✔️ Instructions for Self-Administering Enoxaparin Sodium Injection

• Select a spot on your abdomen's right or left side, at least 5 cm away from your belly button.
• Avoid areas near scars, bruises, or recent injection sites.
• Rotate between the left and right sides of your stomach to prevent irritation.
• Wash your hands thoroughly.
• Use an alcohol swab or soap and water to cleanse the area. Do not rub the site.
• Sit or lie in a relaxed position where you can easily see the injection site. Use a recliner or bed with pillows for support if needed.

✔️ Selecting Your Dose

• Carefully pull off the cap and discard it.
• Avoid pressing the plunger to expel air bubbles, which may reduce the dose.
• Do not allow the needle to touch any surfaces.
• If your syringe has the correct pre-filled dose, no adjustment is needed.
• For weight-based dosing, adjust by pointing the syringe downward and ejecting excess medicine into a container.
• Tap the syringe gently while holding it downward to remove any air bubbles.

✔️ Administering the Injection

• Use the hand you write with, holding the syringe like a pencil.
• Use your other hand to gently pinch a fold of skin between your thumb and forefinger. Maintain the fold throughout the injection.
• Hold the syringe at a 90° angle (straight down) and insert the full length of the needle into the skin fold.
• Press the plunger with your thumb until all the medicine is injected into the fatty tissue.

✔️ After the Injection

• Do not rub the injection site to prevent bruising.
• Place the used syringe into a sharps container.
• Close the container securely and store it out of children’s reach.
• Follow your doctor’s or pharmacist’s instructions for disposing of the full container and any unused medication.
• Store the medicine as instructed, away from children and extreme temperatures.

✔️ Agents affecting hemostasis:

• Medications such as acetylsalicylic acid (aspirin), NSAIDs (e.g., ketorolac), ticlopidine, clopidogrel, dextran 40, glucocorticoids, thrombolytics, anticoagulants, and antiplatelet agents (e.g., glycoprotein IIb/IIIa antagonists) should be discontinued before initiating Cardinex unless strictly necessary.
• If combined use is required, careful clinical and laboratory monitoring is essential.

✔️ Contraindications

• Patients with known hypersensitivity to Enoxaparin Sodium, heparin, or other low molecular weight heparins.
• Conditions with a high risk of uncontrolled hemorrhage, such as recent hemorrhagic stroke or major bleeding.

✔️ Overdose Effects:

• Overdose effects:
  • May cause hemorrhagic complications.
• Neutralization:
  • Administer protamine sulfate (1% solution) intravenously.
  • Dosage: 1 mg of protamine sulfate neutralizes 1 mg of Cardinex.

✔️ Side Effects

• Common:
  • Bleeding (hemorrhage), thrombocytopenia (low platelet count), and elevated liver enzymes (aminotransferase).
  • Pain, bruising, or rash at injection sites.
• Serious:
  • Cases of neuraxial hematomas with spinal/epidural anesthesia or spinal puncture, potentially cause neurological injury.

✔️ Elderly patients:

• No dosage adjustment unless renal function is impaired.

✔️ Renal impairment:

• Moderate to mild impairment (creatinine clearance 30–80 ml/min): No adjustment needed but monitor for bleeding signs.
• Severe impairment (creatinine clearance <30 ml/min):
  • Prophylaxis: 2000 anti-Xa IU once daily.
  • Therapeutic: 100 anti-Xa IU/kg once daily.

✔️ Hepatic impairment:

• Use cautiously in hepatically impaired patients.

✔️ Pregnancy & Lactation

• Pregnancy:
  • Classified as Category B. While no evidence suggests Enoxaparin Sodium crosses the placenta, it should only be used during pregnancy if clearly necessary.
  • Pregnant women with mechanical prosthetic heart valves may have an increased risk of thromboembolism.
• Lactation:
  • Unknown if excreted in human milk. Consider risks to the nursing infant when deciding whether to discontinue nursing or Enoxaparin.

✔️ Precautions & Warnings

• Administer subcutaneously for treatment and prophylaxis.
• Administer intravascularly during hemodialysis.
• Do not inject intramuscularly.
  • Increased bleeding risk (e.g., impaired hemostasis, peptic ulcers, recent stroke, severe hypertension, diabetic retinopathy).
  • Regularly monitor platelet counts during treatment.
  • Caution when combined with medications affecting hemostasis.

✔️ Storage:

• Store in a cool, dry place (below 25°C) and protect from light and moisture.
• Do not refrigerate or freeze.
• Keep out of the reach of children.