Lovenox Overdosage

Accidental overdose following subcutaneous administration of massive doses of low molecular weight heparin may result in hemorrhagic complications.
In case of hemorrhage, certain patients can be treated with protamine sulfate, taking the following factors into account: its efficacy is far lower than that reported in overdoses with unfractionated heparin; due to its unwanted effects (particularly anaphylactic shock), the benefit/risk ratio of protamine sulfate should be carefully weighed beforehand.
Neutralization is performed by slow intravenous injection of protamine (sulfate or hydrochloride).
The protamine dose required depends on: The heparin dose injected (100 anti-heparin units of protamine neutralizes the activity of 100 anti-Xa IU of low molecular weight heparin), if the enoxaparin sodium was administered within the last 8 hours.
The time since the heparin injection: An infusion of 50 anti-heparin units of protamine per 100 anti-Xa IU of enoxaparin sodium can be administered if the enoxaparin sodium was given more than 8 hours earlier, or if a second dose of protamine appears necessary; administration of protamine is not necessary if the enoxaparin injection was given more than 12 hours earlier. The above recommendations are intended for patients with normal renal function receiving repeated doses.
Nevertheless, the anti-Xa activity of enoxaparin cannot be completely neutralized.
Furthermore, the neutralization may only be transient due to the absorption pharmacokinetics of low molecular weight heparin.
This may require dividing the total calculated dose of protamine into several injections (2 to 4) given over 24 hours.
Serious consequences are likely after ingestion of low molecular weight heparin, even in massive quantities (no cases reported), due to the low gastric and intestinal absorption of the drug.