Edoxaban is a prescription medication belonging to the class of direct oral anticoagulants (DOACs). It functions as a Factor Xa inhibitor, blocking the activity of the clotting protein Factor Xa. By inhibiting this factor, edoxaban slows the blood clotting process, reducing the risk of forming dangerous blood clots. The primary goal of this therapy is to prevent serious thromboembolic events in patients who are at risk.
Approved Uses and Standard Dosage
The standard dosage of edoxaban is generally 60 mg taken once daily, though this dose depends on the medical condition being treated. The drug is primarily approved for two uses: reducing the risk of stroke in people with nonvalvular atrial fibrillation (NVAF) and treating venous thromboembolism (VTE). NVAF is an irregular heart rhythm that can cause blood to pool and form clots in the heart, potentially leading to a stroke. For NVAF, the 60 mg daily dose is typically prescribed to prevent systemic embolism events.
The second use is for treating venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is a clot that forms in a deep vein, often in the legs, while PE occurs when a clot travels to the lungs. For VTE treatment, edoxaban is not started immediately. It is used only after a patient has received an initial course of treatment with an injectable anticoagulant.
This initial injectable therapy, such as heparin or low molecular weight heparin, must be given for a minimum of five to ten days. Once this initial phase is complete, the patient transitions to the 60 mg daily dose of edoxaban to continue treating the clot and prevent recurrence. Edoxaban therapy is often continued long-term for NVAF patients, while the duration for VTE is individualized based on the patient’s risk factors.
Determining Individualized Dose Adjustments
The final prescribed dose of edoxaban is not fixed for every patient. The standard 60 mg daily dose is reduced to 30 mg daily if certain clinical factors are present. This adjustment maintains the drug’s effectiveness while lowering the risk of bleeding, which increases if the drug concentration in the blood is too high. Clinicians assess a patient for three specific factors that may necessitate this dose reduction.
One factor is the patient’s renal function, measured by calculating the Creatinine Clearance (CrCl). CrCl estimates how well the kidneys filter waste from the blood. Since edoxaban is partly cleared through the kidneys, impaired function can lead to drug accumulation. A dose reduction to 30 mg is required if a patient’s CrCl falls within the range of 15 to 50 mL/min. Edoxaban is not recommended for patients with poor kidney function (CrCl below 15 mL/min) or those undergoing dialysis.
Body weight is another factor influencing the drug concentration in the bloodstream. Patients who weigh 60 kilograms (about 132 pounds) or less typically require the lower 30 mg dose, even if their kidney function is normal. Reduced body weight can cause a higher blood concentration of edoxaban, increasing the potential for bleeding complications.
Dose reduction is also necessary when edoxaban is taken concurrently with specific P-glycoprotein (P-gp) inhibitors. P-glycoprotein is a protein pump that helps move drugs out of cells. P-gp inhibitors block this function, causing edoxaban to remain in the body longer. Examples of strong P-gp inhibitors requiring a 30 mg dose reduction include certain antifungal drugs like ketoconazole and anti-arrhythmic medications like dronedarone or quinidine.
Practical Guidelines for Daily Edoxaban Use
Edoxaban is designed for once-daily administration. It is best to take the tablet at the same time each day to maintain consistent blood levels. The medication can be taken with or without food, providing flexibility. Following the prescribed schedule precisely is important because the drug’s effect can begin to wear off if doses are missed.
If a dose is missed, the patient should take it immediately upon remembering on the same day. If an entire day has passed and it is time for the next scheduled dose, the patient must skip the missed dose and resume the regular schedule. Never take two doses on the same day to compensate for a forgotten one.
Patients must inform their healthcare providers about any upcoming medical or dental procedures, including surgery. Edoxaban may need to be temporarily stopped (interrupted) before certain procedures to minimize the risk of excessive bleeding. The exact timing for stopping the drug is determined by the prescribing physician, considering the patient’s individual bleeding risk and the type of procedure.