Leaflet: information for the user

Enoxaparin Rovi 2,000 UI (20 mg)/0.2 ml injectable solution in pre-filled syringe

enoxaparin sodium

Read this leaflet carefully before you start using this medicine, because it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, consult your doctor, pharmacist or nurse.

-This medicine has been prescribed for you only. Do not give it to others even if they have the same symptoms as you, as it may harm them.

• If you experience any side effects, consult your doctor or pharmacist, even if they are not listed in this leaflet. See section 4.

1. What isEnoxaparin Roviand what it is used for

2. What you need to know before starting to useEnoxaparin Rovi

3. How to useEnoxaparin Rovi

4. Possible side effects

5. Storage ofEnoxaparin Rovi

6. Contents of the pack and additional information

Enoxaparina Rovicontains an active ingredient called enoxaparin sodium, which is a low molecular weight heparin (LMWH).

Enoxaparina Roviacts in two ways:

1. Preventing existing blood clots from growing larger. This helps your body break them down and prevent further damage.
2. Interrupting the formation of blood clots.

Enoxaparina Rovimay be used for:

• Treating blood clots.
• Preventing blood clots from forming in the following situations:

• Before and after a surgical operation.
• When you have an acute illness and need to be immobile for a period.
• If you have had a blood clot due to cancer, to prevent further clots from forming.
• When you have unstable angina (a condition where not enough blood reaches the heart).
• After a heart attack.

• Preventing blood clots from forming in dialysis tube apparatus (used in people with severe kidney problems).

No use Enoxaparina Rovi

• If you are allergic to enoxaparina sodium or to any of the other components of this medication (listed in section 6). Signs of an allergic reaction include: rash, difficulty swallowing or breathing, swelling of the lips, face, throat, or tongue.
• If you are allergic to heparin or to other low molecular weight heparins, such as nadroparina, tinzaparina, or dalteparina.
• If you have had any reaction to heparin that caused a severe decrease in the number of platelets (a reaction known as heparin-induced thrombocytopenia) in the last 100 days or if you have antibodies against enoxaparina in your blood.
• If you are bleeding heavily or have a high risk of bleeding (such as stomach ulcers, recent eye or brain surgery), including recent hemorrhagic stroke.
• If you are using Enoxaparina Rovi to treat blood clots and are to receive spinal or epidural anesthesia or lumbar puncture within 24 hours.

Warnings and precautions

Do not exchange Enoxaparina Rovi with other medications in the low molecular weight heparin group. This is because they are not exactly the same and do not have the same activity or usage instructions.

Consult your doctor or pharmacist before starting to use Enoxaparina Rovi if:

• You have ever had a reaction to heparin that caused a severe decrease in the number of platelets
• You are to receive spinal or lumbar anesthesia or lumbar puncture (see "Surgical procedures and anesthesia"): a delay between Enoxaparina Rovi and the use of this procedure should be respected
• You have had a heart valve implanted
• You have endocarditis (a heart infection)
• You have a history of stomach ulcers
• You have recently had a stroke (cerebral hemorrhage)
• You have high blood pressure
• You have diabetes or eye blood vessel problems caused by diabetes (diabetic retinopathy)
• You have recently had eye or brain surgery
• You are an elderly person (over 65 years old), especially if you are over 75 years old
• You have kidney problems
• You have liver problems
• You are severely underweight or overweight
• You have high potassium levels in your blood (which could be checked with a blood test)
• You are currently using medications that affect bleeding (see below - Use of Enoxaparina Rovi with other medications).

You may need to have a blood test before starting to use this medication, and while you are using it; this is to check the level of platelets and potassium levels in your blood.

Children and adolescents

The safety and efficacy of enoxaparina have not been evaluated in children or adolescents.

Use of Enoxaparina Rovi with other medications

Inform your doctor or pharmacist if you are using, have used recently, or may need to use any other medication.

• Warfarin - used to reduce blood coagulation
• Aspirin (also known as acetylsalicylic acid or AAS), clopidogrel, or other medications used to interrupt blood clot formation (see also section 3, "Change of anticoagulant treatment")
• Dextran injection - used as a blood substitute
• Ibuprofen, diclofenac, ketorolac, and other medications known as nonsteroidal anti-inflammatory drugs used to treat pain and inflammation in arthritis and other diseases
• Prednisolone, dexamethasone, and other medications used to treat asthma, rheumatoid arthritis, and other diseases
• Medications that increase potassium levels in the blood, such as potassium salts, diuretics, and some medications used to treat heart problems.

Surgical procedures and anesthesia

If you are to undergo a lumbar puncture or are to undergo a surgical procedure where spinal or epidural anesthesia is to be used, inform your doctor that you are using Enoxaparina Rovi. See "Use of Enoxaparina Rovi with other medications". Also inform your doctor if you have any problems with your spine or if you have undergone spinal surgery.

Pregnancy and breastfeeding

If you are pregnant, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medication.

If you are pregnant and have a mechanical heart valve, you may have a higher risk of blood clots. Your doctor will discuss this with you.

If you are breastfeeding or plan to breastfeed, you should consult your doctor before using this medication.

Driving and operating machinery

Enoxaparina Rovi does not affect the ability to drive and operate machinery.

It is recommended that the healthcare professional note the commercial name and batch number of the product you are using.

Enoxaparina Rovi contains sodium

This medication contains less than 23 mg of sodium (1 mmol) per dose; this is, essentially "sodium-free".

Follow exactly the administration instructions of this medication as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

Medication use

• Your doctor or nurse will normally administer Enoxaparin Rovi. This is because it has to be administered by injection.
• When you return home, you may need to continue using Enoxaparin Rovi and administer it yourself (see the instructions on how to do it).
• Enoxaparin Rovi is usually administered by subcutaneous injection.
• Enoxaparin Rovi can be administered by intravenous injection after certain types of heart attacks and surgical operations.
• Enoxaparin Rovi can be added to the tube that comes out of the body (arterial line) at the beginning of dialysis.

Do not administer Enoxaparin Rovi intramuscularly.

How much will be administered

• Your doctor will decide how much Enoxaparin Rovi will be administered. The amount will depend on the reason it is being used.
• If you have any kidney problems, you may be administered a smaller amount of Enoxaparin Rovi.

• The usual dose is 150 UI (1.5 mg) per kilogram of body weight per day or 100 UI (1 mg) per kilogram of body weight twice a day.
• Your doctor will decide how long you will receive Enoxaparin Rovi.

?Surgery or periods of limited mobility due to illness

• The dose will depend on the likelihood that you will develop a blood clot. You will be administered 2,000 UI (20 mg) or 4,000 UI (40 mg) of Enoxaparin Rovi per day.
• If you are going to have surgery, you will usually be administered the first injection 2 or 12 hours before the operation.
• If you have limited mobility due to illness, you will usually be administered 4,000 UI (40 mg) of Enoxaparin Rovi per day.
• Your doctor will decide how long you will receive Enoxaparin Rovi.

?After having a heart attack

Enoxaparin Rovi can be used in two different types of heart attacks, known as STEMI (ST-elevation myocardial infarction) or non-STEMI (NSTEMI). The amount of Enoxaparin Rovi that will be administered will depend on your age and the type of heart attack you have had.

Non-STEMI heart attack:

• The usual dose is 100 UI (1 mg) per kilogram of body weight every 12 hours.
• You will usually be told to also take aspirin (acetylsalicylic acid).
• Your doctor will decide how long you will receive Enoxaparin Rovi.

STEMI heart attack if under 75 years:

• You will be administered an initial intravenous injection of 3,000 UI (30 mg) of Enoxaparin Rovi.
• At the same time, you will be administered a subcutaneous injection of Enoxaparin Rovi. The usual dose is 100 UI (1 mg) per kilogram of body weight every 12 hours.
• You will usually be told to also take aspirin (acetylsalicylic acid).
• Your doctor will decide how long you will receive Enoxaparin Rovi.

STEMI heart attack if 75 years or older:

• The usual dose is 75 UI (0.75 mg) per kilogram of body weight every 12 hours.
• The maximum amount of Enoxaparin Rovi administered in the first two injections is 7,500 UI (75 mg).
• Your doctor will decide how long you will receive Enoxaparin Rovi.

For patients undergoing percutaneous coronary intervention (PCI):

Depending on when you were last administered an injection of Enoxaparin Rovi, your doctor may decide to administer an additional dose of Enoxaparin Rovi before a PCI procedure. This will be administered by intravenous injection.

• The usual dose is 100 UI (1 mg) per kilogram of body weight.
• Enoxaparin Rovi is added to the tube that comes out of the body (arterial line) at the beginning of dialysis. This amount is usually sufficient for a 4-hour session. However, your doctor may perform a new injection of 50 UI to 100 UI (0.5 to 1 mg) per kilogram of body weight if necessary.

Instructions for using the syringe

If you are going to inject Enoxaparin Rovi yourself

If you can administer Enoxaparin Rovi yourself, your doctor or nurse will show you how to do it. Do not try to inject yourself if you have not been taught how to do it. If you do not know what to do, consult your doctor or nurse immediately. If the injection is performed correctly under the skin (which is called "subcutaneous injection"), this will help reduce pain and hematoma at the injection site.

Before injecting yourself with Enoxaparin Rovi

?Prepare what you will need: syringe, cotton swab with alcohol or soap and water, and sharp object container.

?Check the expiration date of the medication. If it has expired, do not use it.

?Check that the syringe is not damaged and that the medication solution is transparent. If not, use another syringe.

?Make sure you know the amount that will be injected.

?Check in the abdominal area if the last injection caused redness, skin color change, swelling, pus, or pain that still persists. If this occurred, consult your doctor or nurse.

Instructions for injecting yourself with Enoxaparin Rovi:

(Instructions for syringes without safety device)

Preparing the injection site

1) Choose a site on the right or left side of your abdomen. At least 5 cm from the navel and towards either side.

?Do not inject within 5 cm of the navel or around it if there are scars or hematomas.

?To inject, alternate the left and right sides of your abdomen, depending on where the last injection was.

2) Wash your hands. Clean (do not rub) the area where you will inject with a cotton swab with alcohol or soap and water.

3) Sit or lie down in a comfortable position so you can relax. Make sure you can see the area where you will inject. It is best to do this in a recliner, a sofa, or a bed with pillows.

Selecting the dose

1) Carefully remove the cap from the syringe needle by pulling it. Dispose of the cap.

?Do not press the plunger to remove air bubbles before injecting. This can cause a loss of medication.

?Once you have removed the cap, do not touch anything with the needle. This will ensure that the needle remains clean (sterile).

2) When the amount of medication in the syringe matches the prescribed dose, there is no need to adjust the dose. You are now ready to administer the injection.

3) When the dose depends on your body weight, you may need to adjust the dose in the syringe to match the prescribed dose. In this case, you can discard the excess medication by keeping the syringe pointing downwards (to keep the air bubble in the syringe) and expelling the excess into a container.

4) A drop may appear at the end of the needle. If this happens, you need to remove the drop before administering the injection by gently tapping the syringe with the needle pointing downwards. You are now ready to administer the injection.

Administering the injection

1. Hold the syringe with the hand that writes (like a pencil). With the other hand, gently pinch the area you cleaned on your abdomen, between your index finger and thumb, to form a fold in the skin.

?Make sure to hold this skin fold in place while the injection is being administered.

1. Hold the syringe so that the needle points straight down (vertically at a 90-degree angle). Insert the entire needle into the skin fold.

3) Press the plunger with your thumb. This will administer the medication into the abdominal fat. Complete the injection by using all the medication in the syringe.

4) Remove the needle from the injection site by pulling it straight out and keeping your finger on the plunger. The needle should be oriented away from you and any other people present. Now you can release the skin fold.

When you have finished

1) To avoid a hematoma, do not rub the injection site after the injection.

2) Dispose of the used syringe in the sharp object container. Close the container lid tightly and place it out of reach of children. When the container is full, dispose of it as instructed by your doctor or pharmacist.

The disposal of unused medication and all materials that have come into contact with it will be done in accordance with local regulations.

If you think the dose is too high (for example, if you have an unexpected hemorrhage) or too low (for example, if the dose does not seem to be working), consult your doctor or pharmacist.

Instructions for syringes with safety device:

Preparing the injection site

1) Choose a site on the right or left side of your abdomen. At least 5 cm from the navel and towards either side.

?Do not inject within 5 cm of the navel or around it if there are scars or hematomas.

?To inject, alternate the left and right sides of your abdomen, depending on where the last injection was.

2) Wash your hands. Clean (do not rub) the area where you will inject with a cotton swab with alcohol or soap and water.

3) Sit or lie down in a comfortable position so you can relax. Make sure you can see the area where you will inject. It is best to do this in a recliner, a sofa, or a bed with pillows.

Selecting the dose

1. Carefully remove the cap from the syringe needle by pulling it. Dispose of the cap.

?Do not press the plunger to remove air bubbles before injecting. This can cause a loss of medication.

?Once you have removed the cap, do not touch anything with the needle. This will ensure that the needle remains clean (sterile).

1. When the amount of medication in the syringe matches the prescribed dose, there is no need to adjust the dose. You are now ready to administer the injection.

3) When the dose depends on your body weight, you may need to adjust the dose in the syringe to match the prescribed dose. In this case, you can discard the excess medication by keeping the syringe pointing downwards (to keep the air bubble in the syringe) and expelling the excess into a container.

4) A drop may appear at the end of the needle. If this happens, you need to remove the drop before administering the injection by gently tapping the syringe with the needle pointing downwards. You are now ready to administer the injection.

Administering the injection

1. Hold the syringe with the hand that writes (like a pencil). With the other hand, gently pinch the area you cleaned on your abdomen, between your index finger and thumb, to form a fold in the skin.

?Make sure to hold this skin fold in place while the injection is being administered.

1. 
   Hold the syringe so that the needle points straight down (vertically at a 90-degree angle). Insert the entire needle into the skin fold.

1. Press the plunger with your thumb. This will administer the medication into the abdominal fat. Complete the injection by using all the medication in the syringe.
2. Remove the needle from the injection site by pulling it straight out and keeping your finger on the plunger. The needle should be oriented away from you and any other people present. The safety device will be activated by firmly pressing the plunger. The protective sleeve will automatically cover the needle and emit an audible click that confirms the activation of the device. Now you can release the skin fold.

When you have finished

1) To avoid a hematoma, do not rub the injection site after the injection.

2) Dispose of the used syringe in the sharp object container. Close the container lid tightly and place it out of reach of children. When the container is full, dispose of it as instructed by your doctor or pharmacist.

The disposal of unused medication and all materials that have come into contact with it will be done in accordance with local regulations.

If you think the dose is too high (for example, if you have an unexpected hemorrhage) or too low (for example, if the dose does not seem to be working), consult your doctor or pharmacist.

Changing anticoagulant treatment

• Switching from Enoxaparin Rovi to medications that reduce blood clotting called vitamin K antagonists (e.g., warfarin)

Your doctor will request a blood test to determine a parameter called INR and tell you when to stop using Enoxaparin Rovi.

• Switching from vitamin K antagonists (e.g., warfarin) to Enoxaparin Rovi

Stop using the vitamin K antagonist. Your doctor will request a blood test to determine a parameter called INR and tell you when to start using Enoxaparin Rovi.

• Switching from Enoxaparin Rovi to direct oral anticoagulants

Stop using Enoxaparin Rovi. Start taking the direct oral anticoagulant 0-2 hours before the next scheduled injection, and then continue as usual.

• Switching from direct oral anticoagulants to Enoxaparin Rovi

Stop taking the direct oral anticoagulant. Do not start using Enoxaparin Rovi until 12 hours after the last dose of the direct oral anticoagulant.

If you use more Enoxaparin Rovi than you should

If you think you have used too much or too little Enoxaparin Rovi, inform your doctor, nurse, or pharmacist immediately, even if you do not show signs of a problem. If a child accidentally injects or ingests Enoxaparin Rovi, take them immediately to the emergency department of a hospital.

In case of overdose or accidental administration, consult your doctor immediately or go to the nearest hospital emergency department, bringing this leaflet with you, or call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount administered.

If you forget to use Enoxaparin Rovi

If you forget to administer a dose, do it as soon as you remember. Do not use a double dose on the same day to compensate for the missed doses. To ensure that you do not forget any doses, it may be helpful to use a calendar.

If you interrupt treatment with Enoxaparin Rovi

If you have any other questions about using this medication, ask your doctor or pharmacist or nurse.

It is essential that you continue to receive Enoxaparin Rovi until your doctor decides to stop treatment. If you stop using it, a blood clot may form, which can be very dangerous.

Like all medicines, this medicine may cause side effects, although not everyone will experience them.

Like other similar medicines (blood-thinning medicines), Enoxaparina Rovi could cause bleeding, which could potentially put your life at risk. In some cases, the bleeding may not be apparent.

If you notice any episode of bleeding that does not stop on its own or if you notice signs of excessive bleeding (unusual weakness, fatigue, paleness, dizziness, headache, or unexplained swelling), consult your doctor immediately.

Your doctor may decide to keep you under close observation or change your medication.

Discontinue treatment with enoxaparina and inform your doctor or nurse immediately if you experience any of the following symptoms:

• Any sign of severe allergic reaction (such as difficulty breathing, swelling of the lips, mouth, throat, or eyes).
• A generalized, red, scaly rash with bumps under the skin and blisters, accompanied by fever. Symptoms usually appear at the beginning of treatment (acute generalized exanthematous pustulosis).

You must inform your doctor immediately

• If you experience any sign of a blood clot blocking a blood vessel, such as:

• Cramp-like pain, redness, heat, or swelling in one of your legs - which are symptoms of deep vein thrombosis.
• Difficulty breathing, chest pain, fainting, or coughing up blood - which are symptoms of pulmonary embolism.

• If you have painful skin rash with dark red spots under the skin that do not disappear when pressed.

Your doctor may request a blood test to check your platelet count.

General list of possible side effects:

Very common(may affect more than 1 in 10 people)

• Bleeding.
• Increased liver enzymes.

Common(may affect up to 1 in 10 people)

• If you notice frequent bruising. This could be due to a blood problem caused by low platelet count.
• Rosacea-like patches on the skin. They appear more frequently in the area where Enoxaparina Rovi has been injected.
• Skin rash (hives, urticaria).
• Redness and itching on the skin.
• Ecchymosis or pain at the injection site.
• Decreased red blood cell count.
• Increased platelet count in the blood.
• Headache.

Uncommon(may affect up to 1 in 100 people)

• Severe sudden headache. This could be a sign of brain hemorrhage.
• Sensation of tenderness to the touch and swelling of the stomach. It could be indicative of gastric hemorrhage.
• Large, irregular skin lesions with or without blisters.
• Skin irritation (local irritation).
• You may notice yellowing of the skin or eyes, and darkening of urine color. This could be due to liver problems.

Rare(may affect up to 1 in 1,000 people)

• Severe allergic reaction. Signs of this reaction may include: skin rash, difficulty swallowing or breathing, swelling of the lips, face, throat, or tongue.
• Increased potassium in the blood. This is more likely to occur in people with kidney problems or diabetes. Your doctor will be able to check it by performing a blood test.
• Increased eosinophil count in the blood. Your doctor will be able to check it by performing a blood test.
• Hair loss.
• Osteoporosis (a disease in which the bones may be more likely to fracture).
• Tickling, numbness, and weakness in the muscles (especially in the lower part of the body) when you have had a lumbar puncture or spinal anesthesia.
• Loss of bladder or bowel control (so you cannot control your needs).
• Hardening or nodule at the injection site.

Reporting side effects

If you experience any type of side effect, consult your doctor, pharmacist, or nurse, even if it is a possible side effect that does not appear in this leaflet.You can also report them directly through the Spanish System for Pharmacovigilance of Medicines for Human Use:www.notificaRAM.es. By reporting side effects, you can contribute to providing more information on the safety of this medicine.

Store below 25 °C. Do not freeze.

Pre-filled syringes of Enoxaparina Rovi contain a single dose; discard any unused portion of the product.

Keep this medication out of the sight and reach of children.

Do not use this medication after the expiration date that appears on the packaging after CAD. The expiration date is the last day of the month indicated.

Do not use this medication if you observe that the syringe is damaged or that the product is not transparent.

Medications should not be disposed of through drains or in the trash.Deposit the packaging and medications that you no longer need at the SIGRE collection pointof the pharmacy.Ask your pharmacist how to dispose of the packaging and medications that you no longer need. In this way, you will help protect the environment.

Composition of Enoxaparina Rovi

• The active ingredient is enoxaparin sodium.

Each pre-filled syringe contains enoxaparin sodium with anti-Xa activity of 2,000 UI (equivalent to 20 mg) in 0.2 ml of water for injection.

• The other components are water for injection.

Appearance of the product and contents of the package

Enoxaparina Rovi is a transparent, colorless to light yellow injectable solution, in a type I glass syringe with a pre-filled injection needle, with or without an automatic safety device. It is presented as follows:

Enoxaparina Rovi 2,000 UI (20 mg)/0.2 ml injectable solution in a 0.5 ml pre-filled syringe without a graduated scale.

Packages of 2, 6, 10, 20, and 50 syringes.

Only some package sizes may be commercially available.

In some package sizes, the pre-filled syringe may be presented with a safety device.

Holder of the marketing authorization and responsible for manufacturing

Holder of the marketing authorization

Laboratorios Farmacéuticos ROVI, S.A.

Julián Camarillo, 35

28037 - Madrid. Spain

Responsible for manufacturing

ROVI Pharma Industrial Services, S.A.

Julián Camarillo, 35

28037 - Madrid. Spain

This medicine is authorized in the member states of the European Economic Area and in the United Kingdom (Northern Ireland) with the following names:

Austria, Denmark, Finland, Germany, Norway, Sweden:Enoxaparin Becat

Italy, Spain, Portugal:Enoxaparina Rovi

Belgium, France, Luxembourg, Netherlands:Enoxaparine Becat

Greece:Enoxaparin Rovi

Slovenia:Enoksaparin Rovi

Bulgaria, Czech Republic, Estonia, Croatia, Hungary, Latvia, Poland, Romania, Slovakia:Losmina

Ireland, United Kingdom (Northern Ireland):Arovi

Date of the last review of this prospectus:January 2025

Other sources of information

The detailed information on this medicine is available on the website of the Spanish Agency for Medicines and Medical Devices (AEMPS) (http://www.aemps.gob.es/)