edoxaban

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Related to Savaysa: edoxaban, Eliquis

edoxaban

(e-dox-a-ban),

Savaysa

(trade name)

Classification

Therapeutic: anticoagulants
Pharmacologic: factor xa inhibitors
Pregnancy Category: C

Indications

Reduction of stroke/systemic embolization (SE) risk associated with nonvalvular atrial fibrillation (NVAF).

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 atrial fibrillation including stroke and systemic embolization.
Treatment of deep vein thrombosis (DVT) and plumonary embolism (PE) after 5–10 days of parenteral anticoagulant.

Pharmacokinetics

Absorption: 62% absorbed following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Minimal metabolism, one metabolite is pharmacologically active. Excreted mostly unchanged in urine.
Half-life: 10–14 hr.

Time/action profile (anticoagulant effect)

ROUTEONSETPEAKDURATION
POunknown1–2 hr24 hr

Contraindications/Precautions

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; Lactation: Discontinue edoxaban or discontinue breastfeeding.
Use Cautiously in: Elective/planned invasive/surgical procudures (discontinue at least 24 hr prior to ↓ risk of bleeding); Premature discontinuation (↑ risk of ischemic events); Neuroaxial anesthesia/spinal puncture (↑ risk of spinal/epidural hematoma and potential paralysis); Renal impairment (dose reduction required for CCr 15–50 mL/min); Deteriorating or improving renal function (may require dose change); Body weight ≤60 kg (requires lower dose); Obstetric: Use during pregnancy only if potential benefit outweighs potential risk to fetus; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Gastrointestinal

  • abnormal liver function tests

Hematologic

  • bleeding (life-threatening)
  • anemia

Interactions

Drug-Drug interaction

Concurrent use of other anticoagulants, antifibrotics, antiplatelet agents, aspirin, fibrinolytics, NSAIDs or SSRIs may ↑ risk of bleeding. Rifampin may ↓ blood levels and effectiveness and is contraindicated.Concurrent use of P-gp inhibitors including azithromycin, clarithromcyin, erythromycin, itraconazole (oral), ketoconazole oral), quinidine, or verapamil ↑ blood levels and the risk of bleeding (lower dose required).

Route/Dosage

Treatment of NVAF

Oral (Adults) 60 mg once daily.

Renal Impairment

Oral (Adults) CCr 15–50 mL/min—30 mg once daily.

Treatment of DVT/PE

Oral (Adults >60 kg) 60 mg once daily.
Oral (Adults ≤60 kg or certain concurrent P-gp inhibitors) 30 mg once daily.

Renal Impairment

Oral (Adults CCr 15–50 ml/min ) 30 mg once daily.

Availability

Tablets: 15 mg, 30 mg, 60 mg

Nursing implications

Nursing assessment

  • Monitor for bleeding. Discontinue edoxaban if active pathological bleeding occurs. Concomitant drugs (aspirin, other antiplatelet agents, other antithrombotic agents, fibrinolytic therapy, chronic use of NSAIDs) may increase risk of bleeding. Anticoagulant effects of edoxaban persist for about 24 hr after last dose; there is no established way to reverse anticoagulant effects. Anticoagulant effects cannot be reliably monitored with standard laboratory tests. No reversal agent is available; protamine sulfate, vitamin K, and tranexamic acid do not reverse anticoagulant activity. Hemodialysis does not significantly contribute to edoxaban clearance.
  • Monitor frequently for signs and symptoms of neurological impairment (numbness or weakness of legs, bowel, or bladder dysfunction, back pain, tingling, muscle weakness); if noted, urgent treatment is required. Intrathecal or epidural catheters should not be removed earlier than 12 hr after last dose of edoxaban. Next dose of edoxaban should not be given less than 2 hr after removal of catheter.
  • Lab Test Considerations: Assess creatinine clearance (CrCl) using Cockcroft-Gault equation (Cockcroft-Gault CrCl = (140-age) x (weight in kg) x (0.85 if female)/(72 x creatinine in mg/dL) before starting therapy.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)

Implementation

  • Discontinue edoxaban at least 24 hr prior to invasive or surgical procedures; may increase risk of bleeding. Edoxaban may be restarted as soon as adequate hemostasis is established; time to onset of pharmacodynamic effect is 1–2 hr.
  • Oral: Nonvalvular Atrial Fibrillation: Administer 60 mg once daily without regard to food. Do not use in patients with CrCl >95 mL/min. If CrCl 15 to 50 mL/min, decrease dose to 30 mg once daily.
  • Deep Vein Thrombosis and Pulmonary Embolism: Administer 60 mg once daily without regard to food following 5 to 10 days of parenteral anticoagulant therapy. If CrCl 15 to 50 mL/min, patient weighs ≤60 kg, or patient taking concurrent verapamil, quinidine, azithromycin, clarithromycin, erythromycin, oral itraconazole or oral ketoconazole, decrease dose to 30 mg once daily.
  • If transitioning from warafarin or other vitamin K antagonists to edoxaban,discontinue warfarin and start edoxaban when INR ≤2.5. If transitioning from oral anticoagulants other than warfarin or other Vitamin K antagonists to edoxaban, discontinue current oral anticoagulant and start edoxaban at time of next scheduled dose of other oral anticoagulant. If transitioning from low molecular weight heparin (LMWH) to edoxaban, discontinue LMWH and start edoxaban at time of next scheduled administration of LMWH. If transitioning from unfractionated heparin to edoxaban, discontinue infusion and start edoxaban 4 hr later.
  • If transitioning from edoxaban to warfarin, Oral Option: For patients taking 60 mg of edoxaban, reduce dose to 30 mg and begin warfarin concomitantly. For patients taking 30 mg edoxaban, reduce dose to 15 mg and begin warfarin concomitantly. Measure INR at least weekly and just prior to daily dose of edoxaban to minimize influence of edoxaban on INR measurements. Once stable INR ≥2.0 achieved, discontinue edoxaban and continue warfarin. Parenteral Option:Discontinue edoxaban and administer a parenteral anticoagulant and warfarin at time of next scheduled edoxaban dose. Once stable INR ≥2.0 achieved, discontinue parenteral anticoagulant and continue warfarin. If transitioning from edoxaban to non-Vitamin-K Dependant Oral anticoagulant, discontinue edoxaban and start other oral anticoagulant at time of next dose of edoxaban. If transitioning from edoxaban to parenteral anticoagulant, discontinue edoxaban and start parenteral anticoagulant at time of next dose of edoxaban.

Patient/Family Teaching

  • Instruct patient to take edoxaban 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 professional; stopping may increase risk of stroke.
  • Caution patient that they may bleed more easily, longer, or bruise more easily during therapy. Advise patient to notify health care professional immediately if bleeding or a fall, especially with head injury, occurs.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially other aspirin or NSAIDs.
  • Advise patient to notify health care professional of therapy before surgery, medical, or dental procedures are scheduled.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected. Avoid breastfeeding during therapy.

Evaluation/Desired Outcomes

  • Decreased thrombotic events (stroke and systemic embolization) associated with atrial fibrillation.
  • Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).
References in periodicals archive ?
For people who take SAVAYSA for nonvalvular atrial fibrillation (a type of irregular heartbeat):
SAVAYSA lowers the chance of having a stroke by helping to prevent clots from forming.
The availability of SAVAYSA now expands our cardiovascular-metabolic U.
With the launch of SAVAYSA, Daiichi Sankyo has developed resources for physicians and patients to help ensure patients can begin and/or remain on SAVAYSA per physician instructions.
SAVAYSA should not be used in patients with creatinine clearance (CrCL) > 95 mL/min because of an increased risk of ischemic stroke compared to warfarin.
IMPORTANT SAFETY INFORMATION FOR SAVAYSA BOXED WARNINGS:
The approval of SAVAYSA demonstrates our commitment to providing new treatment options for cardiovascular diseases with significant unmet needs and reinforces our leadership in factor Xa-inhibition research, which began more than 30 years ago, said Joji Nakayama, Representative Director, President and Chief Executive Officer, Daiichi Sankyo Company, Limited.
Savaysa also has been approved to treat deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients who have already been treated with an anti-clotting drug administered by injection or infusion (parenterally), for five to ten days.
In ENGAGE AF-TIMI 48, SAVAYSA demonstrated significantly less major bleeding in patients with NVAF in the overall study population (hazard ratio[HR], 0.
One in three MCOs will not reimburse Savaysa if priced at the same level as Xarelto.