edoxaban

Contraindicated in:

Active bleeding;
CCr >95 mL/min (↓ effectiveness);
Concurrent use of other anticoagulants or rifampin;
Presence of mechanical heart valves or severe mitral stenosis;
Moderate to severe hepatic impairment;
Triple-positive antiphospholipid syndrome (↑ risk of thrombosis);
Lactation: Lactation.

Use Cautiously in:

Elective/planned invasive/surgical procedures (discontinue at least 24 hr prior to ↓ risk of bleeding);
Premature discontinuation (↑ risk of ischemic events);
Neuroaxial spinal anesthesia or spinal puncture, especially if concurrent with an indwelling epidural catheter; drugs affecting hemostasis; history of traumatic/repeated spinal puncture; or spinal deformity (↑ risk of spinal hematoma)
;
Renal impairment (↓ dose for CCr 15–50 mL/min);
Deteriorating or improving renal function (may require dose change);
Body weight ≤60 kg (requires lower dose);
Rep: Women of reproductive potential;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

GI: ↑liver enzymes

Hemat: anemia, BLEEDING

Interactions ⬆ ⬇

Drug-drug:

Rifampin may ↓ levels and effectiveness; concurrent use contraindicated.
↑risk of bleeding with other anticoagulants, aspirin, clopidogrel, ticagrelor, prasugrel, fibrinolytics, NSAIDs, SNRIs, or SSRIs.
P-glycoprotein (P-gp) inhibitors, including azithromycin, clarithromycin, erythromycin, itraconazole (oral), ketoconazole (oral), quinidine, or verapamil, may ↑ levels and risk of bleeding; lower dose required.

Availability ⬆ ⬇

Tablets: 15 mg; 30 mg; 60 mg

Route/Dosage ⬆ ⬇

Treatment of Nonvalvular Atrial Fibrillation

PO (Adults ): 60 mg once daily.

Renal Impairment

PO (Adults ): CCr 15–50 mL/min: 30 mg once daily.

Treatment of Deep Vein Thrombosis/Pulmonary Embolism

PO (Adults >60 kg): 60 mg once daily. Concurrent use of P-gp inhibitors (verapamil, quinidine, azithromycin, clarithromycin, erythromycin, itraconazole [PO], or ketoconazole [PO]): 30 mg once daily.
PO (Adults ≤60 kg): 30 mg once daily.

Renal Impairment

PO (Adults ): CCr 15–50 mL/min: 30 mg once daily.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Selective inhibitor of factor Xa. Does not inhibit platelet aggregation directly, but does inhibit thrombin-induced platelet aggregation. Decreases thrombin generation and thrombus development.

Therapeutic effects:

Decreased thrombotic events associated with AF, including stroke and systemic embolization.
Resolution of DVT and PE.

Classifications ⬆ ⬇

Therapeutic Classification: anticoagulants

Pharmacologic Classification: factor xa inhibitors

Pharmacokinetics ⬆ ⬇

Absorption: 62% absorbed following oral administration.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Minimal metabolism; one metabolite is pharmacologically active. Excreted mostly unchanged in urine.

Half-Life: 10–14 hr.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(anticoagulant effect)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1–2 hr	24 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Instruct patient to take as directed. Take missed doses as soon as remembered on same day. Return to regular schedule next day. Do not double doses in one day. Do not discontinue without consulting health care provider; may ↑ risk of stroke, DVT, or PE. If temporarily discontinued, restart as soon as possible. Advise patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
Caution patient that they may bleed more easily, longer, or bruise more easily during therapy. Advise patient to notify health care provider immediately if bleeding or a fall, especially with head injury, occurs.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications, especially aspirin or NSAIDs.
Inform patient having had neuraxial anesthesia or spinal puncture to watch for signs and symptoms of spinal or epidural hematoma (numbness or weakness of legs, bowel or bladder dysfunction). Notify health care provider immediately if symptoms occur.
Advise patient to notify health care provider of therapy before surgery, medical, or dental procedures are scheduled.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding during therapy. May ↑ risk of uterine bleeding in women of reproductive potential and those with abnormal uterine bleeding. Monitor neonates for bleeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇