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Practical aspects of apixaban use in clinical practice: continuing the theme

https://doi.org/10.20996/1819-6446-2015-11-5-543-547

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Abstract

Currently there are no generally accepted guidelines for the use of apixaban together with CYP3A4 and/or P-glycoprotein (P-gp) inhibitors. Analysis of clinical and pharmacological studies suggests that apixaban dose should be reduced to 2.5 mg twice daily when co-administered with a strong CYP3A4 and P-gp inhibitors, such as azole antimycotics, HIV protease inhibitors and clarithromycin. However, it is preferred to avoid apixaban combination with strong CYP3A4 and P-gp inhibitors in patients with a creatinine clearance (CrCl) <30 mL/min. According to preliminary calculations, apixaban dose should also be adjusted in patients with CrCl <70-80 ml/min, receiving less potent inhibitors of CYP3A4 and/or P-gp, such as diltiazem, naproxen, verapamil, amiodarone and quinidine. 

About the Author

S. N. Bel'diev
Tver State Medical University. Sovetskaja ul. 4, Tver, 170100 Russia
Russian Federation


References

1. Sychev D.A., Sinitsina I.I., Zakharova G.Yu., et al. Practical aspects of apixaban use in clinical practice: view point of clinical pharmacologist. Ration Pharmacother Cardiol 2015;11(2):209-16. Russian (Сычев Д.А., Синицина И.И., Захарова Г.Ю. и др. Практические аспекты применения апиксабана в клинической практике: взгляд клинического фармаколога. Рациональная Фармакотерапия в Кардиологии 2015;11(2):209-16).

2. Bristol-Myers Squibb Australia. Eliquis (apixaban) approved product information (revised May 2015). Available at: http://www.bmsa.com.au/products/pages/Home.aspx. Accessed by July 26, 2015.

3. Bristol-Myers Squibb Company. Eliquis (apixaban) package insert (revised June 2015). Available at: http://packageinserts.bms.com/pi/pi_eliquis.pdf. Accessed by July 27, 2015.

4. The State Register of Medical Products. Eliquis (apixaban) prescribing information. Available at: http://grls.rosminzdrav.ru/Grls_View_v2.aspx?idReg=85745&t. Accessed by July 28, 2015. Russian (Государственный реестр лекарственных средств. Эликвис (апиксабан): инструкция по применению. Доступно на: http://grls.rosminzdrav.ru/Grls_View_v2.aspx?idReg=85745&t. Дата доступа: 28.07.2015).

5. European Medicines Agency. Eliquis: EPAR product information (last updated May 4, 2015). Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf. Accessed by July 27, 2015.

6. Ward C., Conner G., Donnan G. et al. Practical management of patients on apixaban: a consensus guide. Thromb J 2013;11(1):27.

7. Kovacs R.J., Flaker G.C., Saxonhouse SJ., et al. Practical management of anticoagulation in patients with atrial fibrillation. J Am Coll Cardiol 2015;65(13):1340-60.

8. National guidelines for the diagnosis and treatment of atrial fibrillation (2012). Available at: http://www.scardio.ru/content/Guidelines/FP_rkj_13.pdf. Accessed by July 28, 2015. Russian (Национальные рекомендации по диагностике и лечению фибрилляции предсердий (2012). Доступно на: http://www.scardio.ru/content/Guidelines/FP_rkj_13.pdf. Дата доступа: 28.07.2015).

9. Diagnosis and treatment of atrial fibrillation. Russian recommendations. Rossiyskiy Kardiologicheskiy Zhurnal 2013;4(102):suppl 3:1-45. Russian (Диагностика и лечение фибрилляций предсердий. Российские рекомендации. Российский Кардиологический Журнал 2013;4(102):приложение 3:1-45).

10. Heidbuchel H., Verhamme P., Alings M., et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15(5):625-51.

11. Frost C.E., Byon W., Song Y., et al. Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015;79:838-46.

12. Frost C., Shenker A., Gandhi M.D., et al. Evaluation of the effect of naproxen on the pharmacokinetics and pharmacodynamics of apixaban. Br J Clin Pharmacol 2014;78(4):877-85.

13. Food and Drug Administration. Eliquis (apixaban): Clinical pharmacology & biopharmaceutics review(s). Application number: 202155Orig1s000. Available at: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202155Orig1s000ClinPharmR.pdf. Accessed by July 27, 2015.

14. Granger C.B., Alexander J.H., McMurray J.J., et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365(11):981-92.

15. Food and Drug Administration. Draft guidance for industry. Drug interaction studies – study design, data analysis and implications for dosing and labeling. Available at: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM292362.pdf. Accessed by July 29, 2015.

16. Shulkin A.V., Yakusheva E.N., Popova N.M. The role of P-glycoprotein in rational pharmacotherapy in cardiology. Ration Pharmacother Cardiol 2013;9(6):701-7. Russian (Щулькин А.В., Якушева Е.Н., Попова Н.М. Роль гликопротеина-Р в рациональной фармакотерапии в кардиологии. Рациональная Фармакотерапия в Кардиологии 2013;9(6):701-7).


For citation:


Bel'diev S.N. Practical aspects of apixaban use in clinical practice: continuing the theme. Rational Pharmacotherapy in Cardiology. 2015;11(5):543-547. (In Russ.) https://doi.org/10.20996/1819-6446-2015-11-5-543-547

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ISSN 1819-6446 (Print)
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