Lovenox IV

[Celia M]

Is anyone giving Lovenox IV, we have just had an MD order it and have not given it by this route and the MD could not give us much evidence other than other hospitals are giving it IV as a bolus when starting anticoagulant therapy. Thanks :)

[acutestemi]

I am a board certified interventional cardiologist. The trials that tested lovenox all used 30 mg IV loading at the same time as 1 mg/kg. In fact, if a hospital does not adopt this method for real unstable angina or acs, they are substandard. The recommendation (as can be found in Journal of Invasive Cardiology) recommends that 30 mg IV be given as a loading dose for acs. The ESSENCE trial protocol which showed that enoxaparin is better than unfractionated heparin used 30 mg IV loading. Hospital policies have to consult cardiologists who in turn have to stick with clinical trial data or else the hospital policy is very behind and substandard.

[vaccrn]

Let me just toss this out there.................

Have any of you ICU/CCU nurses ever given Haldol IV (read the vial "for IM adminisration")? I worked for 7 years in the CCU and I know that that I gave Haldol IV more times than I can count. The FDA HAS NEVER approved Haldol for IV adminisatration, but we all do it because it works. Why mess with success????

[Leahr]

Our facility is sub q only

[UM Review RN, ASN, RN]

let me just toss this out there.................

have any of you icu/ccu nurses ever given haldol iv (read the vial "for im adminisration")? i worked for 7 years in the ccu and i know that that i gave haldol iv more times than i can count. the fda has never approved haldol for iv adminisatration, but we all do it because it works. why mess with success????

ummm....not sure if "success" is the right word for some of these unfortunate patients. from medline: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682180.html

important warning:

[posted 09/17/2007] johnson and johnson and fda informed healthcare professionals that the warnings section of the prescribing information for haloperidol has been revised to include a new cardiovascular subsection regarding cases of sudden death, qt prolongation and torsades de pointes(tdp) in patients treated with haloperidol, especially when given intravenously, or at doses higher than recommended. although injectable haloperidol is only approved by the fda for intramuscular injection, there is considerable evidence that the intravenous administration of haloperidol is a relatively common off-label clinical practice.

there are at least 28 case reports of qt prolongation and tdp, some with fatal outcome in the context of off-label intravenous haloperidol. healthcare professionals should consider this new risk information when making individual treatment decisions for their patients. for more information visit the fda website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#haloperidol and http://www.fda.gov/cder/drug/infosheets/hcp/haloperidol.htm.

[ckc6977]

Our hospital only uses Lovenox via SC. I find it very interesting it may be given as an IV bolus and will inquire about this c our cardiologists.