Antidote for lovenox1/30/2024 Your doctor will tell you what you should do if you experience an attack of angina. Your doctor will probably start you on a low dose of ranolazine and gradually increase your dose.ĭo not take ranolazine to treat a sudden attack of angina. Swallow the tablets whole do not break, chew, or crush them. Do not take more or less of it or take it more often than prescribed by your doctor. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ranolazine at around the same times every day. It is usually taken with or without food twice daily. The anti-factor Xa level at 24 hours was 1.39 IU/mL.Ranolazine comes as an extended-release (long-acting) tablet to take by mouth. Subsequent testing for anti-factor Xa revealed an initial level of 4.72 IU/mL upon admit (therapeutic range 0.50 – 1.10 IU/mL), decreasing to 4.52 and 3.82 IU/mL after the infusions of protamine sulfate. The patient did not exhibit any signs of bleeding during treatment, and tolerated the infusions of protamine sulfate without any adverse effects. Rebound phenomenon was noted 3–8.5 hours later as the aPTT increased (70 to 89 seconds), however, no additional protamine sulfate was given. A second infusion of protamine sulfate was administered 2 hours later, and the aPTT decreased further to 49 seconds. An initial dose of protamine sulfate, 250 mg mixed in 500 ml of 0.9% sodium chloride, was infused over 3–4 hours. Anti- factor Xa levels were not available at the time of treatment. Initial laboratory assessment, approximately 2 hours post-suicide attempt, revealed an elevated aPTT of >150 seconds (reference range 23–38 seconds). The remainder of his physical exam was unremarkable, and he exhibited no overt signs of bleeding. He was somnolent but arousable with bruising noted around multiple injection sites on his abdomen. Upon admission, he reported self-administration of 20 subcutaneous injections of 100 mg of enoxaparin (2000 mg) and 8 tablets of quetiapine (400 mg/tablet) in an attempt to commit suicide. We report a challenging case of a large overdose of LMWH, successfully treated despite the lack of appropriate laboratory monitoring tests.Ī 50-year old Caucasian man with a past medical history significant for bipolar disorder, schizophrenia, hypertension, and pulmonary embolism secondary to a hypercoagulable state caused by tetrahydrofolate reductase deficiency was found unresponsive and transported to the emergency department. Anti-factor Xa levels, however, are not readily available at most institutions. Peak plasma levels of LMWH are found 3–4 hours after administration, and the half-life of the drug is 4.5–7 hours. Plasma levels of LMWH can be monitored by measuring anti-factor Xa levels however, studies correlating large overdoses have not been performed. Both cases were treated with an approximate 1 to 1 ratio of protamine sulfate to LMWH (30 mg and 20 mg, respectively) and showed incomplete reversal of anticoagulation. Two reports of enoxaparin overdose have been described in the literature a neonate received a 10-fold overdose and a 64-year old man received an extra daily dose. Due to its safety profile, there has been little literature regarding management and treatment of overdoses. Enoxaparin, a low molecular weight heparin (LMWH), is used for prophylaxis and treatment of venous and arterial thromboembolism.
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