Generic Name

Edoxaban Tosylate

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Classification

FDA Approved Indications

• Stroke prevention in non-valvular atrial fibrillation
• Treatment of venous thromboembolism (deep vein thrombosis and pulmonary embolism) and reduction of risk of recurrent DVT and PE

Mechanism of Action

Edoxaban selectively inhibits factor Xa, which decreases thrombin generation and thrombus development.

Dosage and Administration

Adult: 60 mg once daily; dose may be reduced to 30 mg once daily in renally impaired patients, or in those taking specific interacting drugs.

Pediatric: Not approved for pediatric use.

Geriatric: Adjust dose based on renal function rather than age alone.

Renal Impairment: Adjust dose based on creatinine clearance: 15-50 mL/min requires dose reduction; contraindicated if CrCl <15 mL/min.

Hepatic Impairment: Use with caution; avoid in severe hepatic impairment.

Pharmacokinetics

Absorption: Rapid and complete absorption; Food increases bioavailability.

Distribution: Protein binding approximately 55%.

Metabolism: Minimal hepatic metabolism; primarily eliminated unchanged.

Excretion: Renal and fecal excretion.

Half Life: 10-14 hours, allowing once-daily dosing.

Contraindications

• Active pathological bleeding
• Severe hypersensitivity to edoxaban

Precautions

• Renal impairment, hepatic impairment, elderly, low body weight, concomitant use of other anticoagulants or antiplatelet agents, risk of bleeding

Adverse Reactions - Common

• Bleeding (Common)
• Anemia (Less common)

Adverse Reactions - Serious

• Major bleeding (e.g., intracranial, gastrointestinal) (Less common but serious)
• Hepatic injury (Rare)

Drug-Drug Interactions

• Other anticoagulants, antiplatelet agents, NSAIDs, selective serotonin reuptake inhibitors (SSRIs), CYP3A4 inhibitors/inducers

Drug-Food Interactions

• No significant food interactions reported

Drug-Herb Interactions

• Herbal products affecting coagulation (e.g., ginkgo, garlic)

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Report any signs of bleeding or unusual bruising.
• Use caution with activities that may cause injury.
• Inform healthcare providers about this medication prior to procedures.

Special Considerations

Black Box Warnings:

• Increased risk of thrombotic events upon abrupt discontinuation in patients with atrial fibrillation.
• Risk of bleeding.

Genetic Factors: No specific genetic testing required.

Lab Test Interference: Can affect certain coagulation tests, but routine laboratory monitoring is generally not necessary.

Overdose Management

Signs/Symptoms: Excessive bleeding, hypotension.

Treatment: Discontinue edoxaban, supportive measures, and use of reversal agents (if available) such as andexanet alfa in certain cases.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable until expiration date when stored properly.