Edoxaban is an anticoagulant medication, often prescribed to help prevent the formation of harmful blood clots within the body. It belongs to a class of drugs known as direct oral anticoagulants (DOACs), specifically acting as a Factor Xa inhibitor. This mechanism of action helps to disrupt the blood clotting cascade, thereby reducing the risk of conditions like stroke or deep vein thrombosis. Precise dosing of edoxaban is important to balance its clot-preventing effects with the potential for bleeding.
Standard Dosing for Common Conditions
For non-valvular atrial fibrillation (NVAF), the recommended dose of edoxaban is 60 mg once daily to reduce the risk of stroke and systemic embolism. This dose can be adjusted for certain patients. Edoxaban is available in 15 mg, 30 mg, and 60 mg tablets.
For deep vein thrombosis (DVT) and pulmonary embolism (PE), or preventing their recurrence, the dose is also 60 mg once daily. This follows an initial 5 to 10-day treatment with a parenteral anticoagulant, such as heparin. The duration of edoxaban therapy for DVT and PE is individualized, often lasting at least three months, depending on the clot’s cause.
Factors Influencing Dosage
Edoxaban dosage varies based on several factors, primarily kidney function. Renal impairment, measured by creatinine clearance (CrCl), influences dosing. For NVAF patients with a CrCl between 15 and 50 mL/min, the dose is reduced to 30 mg once daily. Edoxaban is not recommended for patients with a CrCl less than 15 mL/min or those undergoing dialysis.
For DVT and PE treatment, a reduced dose of 30 mg once daily is also recommended if CrCl is between 15 and 50 mL/min. Edoxaban is not advised for NVAF patients with a CrCl greater than 95 mL/min, as studies show an increased risk of ischemic stroke compared to warfarin in this group. Healthcare professionals assess baseline kidney function to determine the appropriate dosage.
Body weight also influences dose adjustment. Patients weighing 60 kg or less require a reduced edoxaban dose of 30 mg once daily for both NVAF and DVT/PE treatment. This adjustment helps prevent elevated drug concentrations and increased bleeding risk.
Drug interactions can also necessitate dose modifications. Concomitant use with certain P-glycoprotein (P-gp) inhibitors increases edoxaban levels, requiring a dose reduction to 30 mg once daily. Examples include ciclosporin, dronedarone, erythromycin, and ketoconazole. Healthcare professionals make these dose adjustments based on a comprehensive assessment of the patient’s health and medication regimen.
Safe Use and Adherence
Adherence to the prescribed edoxaban dose and schedule is important for effectiveness and patient safety. Patients should take edoxaban once daily, preferably at the same time each day, with or without food. Consistency helps maintain stable drug levels, reducing the risk of blood clot formation.
If a dose is missed, patients should take it as soon as they remember. However, if it is almost time for the next scheduled dose (e.g., less than 12 hours), the missed dose should be skipped, and the regular schedule resumed. Never take a double dose to compensate, as this increases bleeding risk.
Self-adjusting the edoxaban dose without consulting a healthcare professional is discouraged. Incorrect dosing can reduce effectiveness in preventing clots or elevate bleeding risk. Patients should be aware of bleeding as a possible side effect, ranging from mild bruising to serious events like gastrointestinal or intracranial bleeding. Seek immediate medical attention for signs of bleeding, such as prolonged or excessive bleeding, unusual bruising, blood in urine or stools, or severe headaches.