Edoxaban and the Issue of Drug-Drug Interactions: From Pharmacology to Clinical Practice

A. Corsini, N. Ferri, M. Proietti, G. Boriani

Research output: Contribution to journalArticlepeer-review

Abstract

Edoxaban, a direct factor Xa inhibitor, is the latest of the non-vitamin K antagonist oral anticoagulants (NOACs). Despite being marketed later than other NOACs, its use is now spreading in current clinical practice, being indicated for both thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF) and for the treatment and prevention of venous thromboembolism (VTE). In patients with multiple conditions, the contemporary administration of several drugs can cause relevant drug-drug interactions (DDIs), which can affect drugs’ pharmacokinetics and pharmacodynamics. Usually, all the NOACs are considered to have significantly fewer DDIs than vitamin K antagonists; notwithstanding, this is actually not true, all of them are affected by DDIs with drugs that can influence the activity (induction or inhibition) of P-glycoprotein (P-gp) and cytochrome P450 3A4, both responsible for the disposition and metabolism of NOACs to a different extent. In this review/expert opinion, we focused on an extensive report of edoxaban DDIs. All the relevant drugs categories have been examined to report on significant DDIs, discussing the impact on edoxaban pharmacokinetics and pharmacodynamics, and the evidence for dose adjustment. Our analysis found that, despite a restrained number of interactions, some strong inhibitors/inducers of P-gp and drug-metabolising enzymes can affect edoxaban concentration, just as it happens with other NOACs, implying the need for a dose adjustment. However, our analysis of edoxaban DDIs suggests that given the small propensity for interactions of this agent, its use represents an acceptable clinical decision. Still, DDIs can be significant in certain clinical situations and a careful evaluation is always needed when prescribing NOACs. © 2020, Springer Nature Switzerland AG.
Original languageEnglish
Pages (from-to)1065-1083
Number of pages19
JournalDrugs
Volume80
Issue number11
DOIs
Publication statusPublished - 2020

Keywords

  • antacid agent
  • anti human immunodeficiency virus agent
  • antibiotic agent
  • anticoagulant agent
  • anticonvulsive agent
  • antidepressant agent
  • antifungal agent
  • antilipemic agent
  • antineoplastic agent
  • antiparkinson agent
  • antithrombocytic agent
  • cardiovascular agent
  • edoxaban
  • hepacivirin inhibitor
  • hydroxymethylglutaryl coenzyme A reductase inhibitor
  • immunomodulating agent
  • interleukin 6
  • monoclonal antibody
  • neuroleptic agent
  • nonsteroid antiinflammatory agent
  • nootropic agent
  • nutraceutical
  • nutrition supplement
  • omega 3 fatty acid
  • clinical practice
  • clinician
  • drug interaction
  • Hepatitis C virus
  • herb
  • herb drug interaction
  • human
  • nonhuman
  • pharmacodynamics
  • pharmacokinetic parameters
  • pharmacologist
  • Review

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