Uses
Edoxaban is an anticoagulant drug which acts as a direct factor Xa inhibitor.
Definition
ChEBI: A hydrate that is the monohydrate of the tosylate salt of edoxaban. Used for the treatment of deep vein thrombosis and pulmonary embolism.
Biological Activity
factor xa (fxa), a key serine protease, is a promising target enzyme for the prophylaxis and treatment of thromboembolic diseases. edoxaban tosylate monohydrate is a novel antithrombotic agent that directly inhibits fxa activity.
Clinical Use
Daichi Sankyo’s edoxaban tosilate is an orally administered
coagulation factor Xa inhibitor that was approved and launched
in Japan for the preventive treatment of venous thromboembolic
events (VTE) in patients undergoing total knee arthroplasty, total
hip arthroplasty, or hip fracture surgery. Edoxaban has been
shown to have a rapid onset of anticoagulant effect due to short
Tmax (1–2 h) after dosing and sustained for up to 24 h post-dose.
Marketed under the brand name Lixiana, it is currently in phase
III studies in the US for the prevention of stroke and systemic embolic
events in patients with atrial fibrillation (AF) and venous
thromboembolism (VTE).
in vitro
edoxaban tosylate monohydrate (du-176b) inhibited fxa with ki values of 0.561 nm for free fxa, 2.98 nm for prothrombinase, and exhibited >10 000-fold selectivity for fxa. du-176b doubled prothrombin time and activated partial thromboplastin time in human plasma. du-176b did not impair platelet aggregation by adp, collagen or u46619 [1].
in vivo
du-176b dose-dependently inhibited thrombus formation in rat and rabbit thrombosis models, although bleeding time in rats was not significantly prolonged at an antithrombotic dose [1].
Drug interactions
Potentially hazardous interactions with other drugs
Analgesics: increased risk of bleeding with NSAIDs
and high dose aspirin; increased risk of haemorrhage
with IV diclofenac and ketorolac - avoid
Anti-arrhythmics: concentration increased by
dronedarone (reduce edoxaban dose)
Antibacterials: concentration increased by
erythromycin (reduce edoxaban dose); concentration
reduced by rifampicin.
Anticoagulants: increased risk of haemorrhage with
other anticoagulants - avoid.
Antidepressants: concentration possibly reduced by
St John’s wort.
Antiepileptics: concentration possibly reduced
by carbamazepine, fosphenytoin, phenobarbital,
phenytoin and primidone.
Antifungals: concentration increased by ketoconazole
(reduce edoxaban dose).
Ciclosporin: concentration of edoxaban increased
(reduce edoxaban dose).
Metabolism
Unchanged edoxaban is main form in plasma.
Edoxaban is metabolised via hydrolysis (mediated
by carboxylesterase 1), conjugation or oxidation by
CYP3A4/5 (<10%). Edoxaban has 3 active metabolites,
the predominant metabolite (M-4), formed by hydrolysis,
is active and reaches less than 10% of the exposure of the
parent compound in healthy subjects. Exposure to the
other metabolites is less than 5%. Edoxaban is a substrate
for the efflux transporter P-glycoprotein (P-gp), but
not a substrate for uptake transporters such as organic
anion transporter polypeptide OATP1B1, organic
anion transporters OAT1 or OAT3 or organic cation
transporter OCT2. Its active metabolite is a substrate for
OATP1B1.
Renal clearance accounts for approximately 35% of the
administered dose. Metabolism and biliary/intestinal
excretion account for the remaining clearance.
References
[1] furugohri t, isobe k, honda y, kamisato-matsumoto c, sugiyama n, nagahara t, morishima y, shibano t. du-176b, a potent and orally active factor xa inhibitor: in vitro and in vivo pharmacological profiles. j thromb haemost. 2008;6(9):1542-9.
[2] bathala ms, masumoto h, oguma t, he l, lowrie c, mendell j. pharmacokinetics, biotransformation, and mass balance of edoxaban, a selective, direct factor xa inhibitor, in humans. drug metab dispos. 2012;40(12):2250-5.