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Edoxaban and the Issue of Drug-Drug Interactions: From Pharmacology to Clinical Practice

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Abstract

Edoxaban, a direct factor Xa inhibitor, is the latest of the non-vitamin K antagonist oral anticoagulants (NOACs). Despite being marketed later than other NOACs, its use is now spreading in current clinical practice, being indicated for both thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF) and for the treatment and prevention of venous thromboembolism (VTE). In patients with multiple conditions, the contemporary administration of several drugs can cause relevant drug-drug interactions (DDIs), which can affect drugs’ pharmacokinetics and pharmacodynamics. Usually, all the NOACs are considered to have significantly fewer DDIs than vitamin K antagonists; notwithstanding, this is actually not true, all of them are affected by DDIs with drugs that can influence the activity (induction or inhibition) of P-glycoprotein (P-gp) and cytochrome P450 3A4, both responsible for the disposition and metabolism of NOACs to a different extent. In this review/expert opinion, we focused on an extensive report of edoxaban DDIs. All the relevant drugs categories have been examined to report on significant DDIs, discussing the impact on edoxaban pharmacokinetics and pharmacodynamics, and the evidence for dose adjustment. Our analysis found that, despite a restrained number of interactions, some strong inhibitors/inducers of P-gp and drug-metabolising enzymes can affect edoxaban concentration, just as it happens with other NOACs, implying the need for a dose adjustment. However, our analysis of edoxaban DDIs suggests that given the small propensity for interactions of this agent, its use represents an acceptable clinical decision. Still, DDIs can be significant in certain clinical situations and a careful evaluation is always needed when prescribing NOACs.

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Modified from Salazar et al. [58]

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Authors and Affiliations

  1. Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy

    Alberto Corsini

  2. Multimedica IRCCS, Milan, Italy

    Alberto Corsini

  3. Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy

    Nicola Ferri

  4. Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy

    Marco Proietti

  5. Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy

    Giuseppe Boriani

  6. Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Marco Proietti

  7. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK

    Marco Proietti

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  1. Alberto Corsini
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  4. Giuseppe Boriani
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Correspondence to Marco Proietti.

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This article was developed independently by the authors following an advisory board meeting sponsored by Daiichi Sankyo SpA.

Conflict of interest

Alberto Corsini reports relationship with Bristol-Mayers, Daiichi-Sankyo and Mylan. Nicola Ferri reports relationship with Bristol-Mayers, Daiichi-Sankyo and Mylan. Marco Proietti reports relationship with Boehringer Ingelheim. Giuseppe Boriani reports relationship with Medtronic, Boston Scientific, Boehringer Ingelheim and Bayer. All relationships disclosed are outside the submitted work.

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Corsini, A., Ferri, N., Proietti, M. et al. Edoxaban and the Issue of Drug-Drug Interactions: From Pharmacology to Clinical Practice. Drugs 80, 1065–1083 (2020). https://doi.org/10.1007/s40265-020-01328-6

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