EdoxabanEdoxaban Tosylate

About Edoxaban

Edoxaban blocks factor Xa, a clotting enzyme. It is approved for adults to lower the risk of stroke and systemic embolism in nonvalvular atrial fibrillation, and to treat deep vein thrombosis and pulmonary embolism after 5 to 10 days of an injected or intravenous anticoagulant. Before starting, the prescriber estimates kidney function as creatinine clearance (CrCl). The usual dose is 60 mg once a day; it is 30 mg once a day when CrCl is 15 to 50 mL/min, and for clots also when body weight is 60 kg or less or with certain medicines that block P-gp, a drug transporter. It is not recommended when CrCl is below 15 mL/min.

The boxed warning covers reduced efficacy, early stopping and spinal bleeding. In atrial fibrillation, edoxaban should not be used when CrCl is above 95 mL/min, because those patients had more ischemic strokes on it than on warfarin in the main study. Stopping any oral anticoagulant early, without another one in its place, raises the risk of clots and stroke. After spinal or epidural anesthesia or a spinal puncture, bleeding around the spinal cord can cause long-term or permanent paralysis. Edoxaban can cause serious, potentially fatal bleeding and is not taken during active abnormal bleeding. It is not recommended with mechanical heart valves, moderate to severe mitral stenosis, triple-positive antiphospholipid syndrome, or moderate or severe liver impairment. In atrial fibrillation, bleeding and anemia were the most common side effects.

The label states that no specific reversal agent for edoxaban is available. It is usually stopped at least 24 hours before surgery or a procedure and restarted once bleeding is controlled, as the prescriber directs. Switching to warfarin follows a plan with weekly INR checks, which is where the 15 mg tablet is used. Data in pregnancy are insufficient to judge the risk, and breastfeeding is not recommended during treatment.

Taking Edoxaban

How to take it

Take it once a day at about the same time, with or without food. If you cannot swallow it whole, it can be crushed, mixed with 2 to 3 ounces of water or applesauce and taken right away.

If you miss a dose

Take the missed dose as soon as you remember on the same day. If it is already the next day, do not make it up; take your next dose at the usual time. Never take two doses to make up for a missed one.

Storage

Keep the tablets in their original container, tightly closed, at room temperature away from heat and moisture, and out of reach of children.

Interactions to know about

Other anticoagulants, antiplatelet medicines such as clopidogrel, aspirin and other NSAIDs, and SSRI or SNRI antidepressants raise the risk of bleeding; rifampin should be avoided. Tell the prescriber about every medicine and supplement you take.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Edoxaban differs from pharmacy to pharmacy

With no generic approved, every edoxaban quote is for Savaysa and is priced as a brand, so differences come from each pharmacy’s cash pricing for brand products and whether it keeps the tablets on the shelf or orders them in.

Another anticoagulant cannot be swapped for edoxaban at the counter; any change needs a new prescription. The dispensing fee is a small part of a brand quote.

Ways to pay less for Edoxaban without insurance

• Ask the pharmacy whether it has Savaysa in stock before the prescription is sent, so there is no gap between doses.
• Ask the maker whether its savings or patient assistance program applies to someone paying cash; many copay cards require commercial insurance.
• Once your dose is settled, ask the prescriber whether a ninety-day supply is appropriate, and refill before you run out, since stopping early raises the risk of stroke and clots.
• Ask the prescriber whether a generic anticoagulant such as warfarin, which needs regular INR blood tests, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Edoxaban

1. 1.Is my dose the standard one or the reduced one, and is it based on my kidney function or my weight?
2. 2.Which pain relievers, antidepressants or supplements raise my bleeding risk with edoxaban?
3. 3.What should I do if I miss a dose or am about to run out?
4. 4.How long before my surgery or dental work should it be stopped, and who decides?

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