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Apixaban Antidote

Apixaban Antidote

About apixaban antidote

The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first factor Xa inhibitor antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.

Use

Coagulation factor Xa (recombinant), inactivated-zhzo (andexanet alfa; Andexxa – Portola) has received accelerated approval from the FDA for urgent reversal of the anticoagulant effect of the direct factor Xa inhibitors apixaban (Eliquis) and rivaroxaban (Xarelto). Andexanet alfa is the second antidote for a direct oral anticoagulant to become available in the US, and the first for factor Xa inhibitors. Idarucizumab (Praxbind) was approved in 2015 for reversal of the anticoagulant effect of the direct thrombin inhibitor dabigatran etexilate (Pradaxa).1 Andexanet alfa has not been approved to date for reversal of anticoagulation with the direct factor Xa inhibitors edoxaban

What you need to know

Direct oral anticoagulants (DOACs) are shown to be safe and effective alternatives to vitamin K antagonists in appropriately selected patients, despite a lack of specific antidotes.

For most bleeding events, expert opinion suggests that cessation of the DOAC and supportive care will likely be sufficient.

Currently, only one specific antidote, idarucizumab, is licensed for use and is indicated to reverse dabigatran in patients with life threatening haemorrhage or need for urgent surgery.

side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

  • bleeding gums.
  • nosebleeds.
  • heavy vaginal bleeding.
  • red, pink, or brown urine.
  • red or black, tarry stools.
  • coughing up or vomiting blood or material that looks like coffee grounds.
  • skin rash,
  • allergic reactions,
  • fainting, nausea, and
  • anemia.

DRUG INTERACTIONS

Apixaban is a substrate of both CYP3A4 and P-gp. Inhibitors of CYP3A4 and P-gp increase exposure to apixaban and increase the risk of bleeding. Inducers of CYP3A4 and P-gp decrease exposure to apixaban and increase the risk of stroke and other thromboembolic events.

Precautions

Before taking apixaban, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, bleeding problems (such as bleeding of the stomach/intestines, bleeding in the brain), blood disorders (such as anemia, hemophilia, thrombocytopenia), recent major injury/surgery, stroke, frequent falls/injuries.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

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