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Vorapaxar, an oral PAR-1 receptor antagonist, does not affect the pharmacokinetics and pharmacodynamics of warfarin

  • Pharmacokinetics and Disposition
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Abstract

Purpose

Vorapaxar is an orally active protease-activated receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet aggregation. This open-label study assessed the pharmacokinetics and pharmacodynamics of single-dose warfarin in the presence/absence of multiple-dose vorapaxar in 12 healthy men.

Methods

Subjects received two treatments separated by ≥7-day washout: Treatment A warfarin 25 mg (Day 1); Treatment B vorapaxar 2.5 mg/day on Days 1–6 and vorapaxar 40 mg coadministered with warfarin 25 mg (Day 7). R-warfarin, S-warfarin, and prothrombin time (PT) were assayed predose and up to 120 h postdose.

Results

The geometric mean ratio (GMR) as a percentage (warfarin + vorapaxar/warfarin) was calculated. The GMR (90 % CIs) estimates of Cmax were 105 (99, 111) and 105 (99, 112) for R- and S-warfarin, respectively. The GMR (90 % CIs) estimates of AUC0-∞ were 108 (101, 116) and 105 (96, 115) for R- and S-warfarin, respectively. The GMR (95 % CIs) estimates of AUC0–120 h for PT and INR were 97 (95, 98) and 96 (94, 98), respectively.

Conclusion

Results of this study indicate that vorapaxar has no meaningful effect on the pharmacokinetics or pharmacodynamics of warfarin, suggesting that the coadministration of these two drugs or vorapaxar coadministered with other CYP2C9/CYP2C19 substrates is unlikely to cause a clinically significant pharmacokinetic drug interaction.

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Acknowledgements

The authors wish to thank the subjects for their participation in this study. The authors also wish to thank Kathleen Newcomb (Merck Sharp & Dohme Corp.) for her expert assistance with the preparation of this manuscript for publication.

Conflict of interest

T. Kosoglou, Y. Zhu, F. Xuan, L. Black, A.O. Johnson-Levonas, M. Martinho, P. Statkevich, and D.L. Cutler all declare that they are/were full-time employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA, at the time of the study and may own stock or hold stock options in the company. This study was funded by Schering-Plough Corporation (now Merck & Co., Inc., Whitehouse Station, NJ).

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Authors and Affiliations

  1. Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA

    Teddy Kosoglou, Yali Zhu, Fengjuan Xuan, Laura Black, Amy O. Johnson-Levonas, Monika Martinho, Paul Statkevich & David L. Cutler

  2. Clinical Pharmacology, Merck Sharp & Dohme Corp, 351 N. Sumneytown Pike, UG4–D48, North Wales, PA, 19454, USA

    Teddy Kosoglou

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  1. Teddy Kosoglou
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  2. Yali Zhu
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  3. Fengjuan Xuan
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  8. David L. Cutler
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Correspondence to Teddy Kosoglou.

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Kosoglou, T., Zhu, Y., Xuan, F. et al. Vorapaxar, an oral PAR-1 receptor antagonist, does not affect the pharmacokinetics and pharmacodynamics of warfarin. Eur J Clin Pharmacol 68, 1509–1516 (2012). https://doi.org/10.1007/s00228-012-1271-0

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  • DOI: https://doi.org/10.1007/s00228-012-1271-0

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