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vorapaxar

General

Pronunciation:
vor-a-pax-ar


Trade Name(s)

  • Zontivity

Ther. Class.
antiplatelet agents

Pharm. Class.
protease-activated receptor-1 (PAR-1) antagonists

Indications

To reduce thrombotic cardiovascular events in patients who have a history of MI or peripheral arterial disease (PAD); can be used with aspirin and/or clopidogrel.

Action

Acts as an antagonist of the protease-activated receptor-1 (PAR-1) on platelet surfaces. Inhibits platelet aggregation.

Therapeutic Effect(s):

Decreased cardiovascular events.

Pharmacokinetics

Absorption: Completely absorbed (100%) following oral administration.

Distribution: Unknown.

Protein Binding: >99%.

Metabolism and Excretion: Extensively metabolized (CYP3A4 and CYP2J2); one metabolite (M20) has antiplatelet activity (20% of parent compound). Excreted mostly in feces (58%) and some in urine (25%) as metabolites.

Half-life: Effective half-life– 3–4 days, terminal elimination half-life– 8 days (range 5–13 days, similar for M20).

TIME/ACTION PROFILE (antiplatelet effect)

ROUTEONSETPEAKDURATION
POwithin 1 wkunknown4 wk

Contraindication/Precautions

Contraindicated in:

  • History of stroke, transient ischemic attack or intracranial hemorrhage;
  • Active pathologic bleeding;
  • Concurrent use of anticoagulants including warfarin;
  • Concurrent use of strong inhibitors or inducers or CYP3A should be avoided;
  • Severe hepatic impairment (↑ risk of bleeding);
  • Lactation:Discontinue vorapaxar or discontinue breast feeding.

Use Cautiously in:

  • Existing risk factors for bleeding including ↑ age, ↓ body weight, ↓ renal/hepatic function, concurrent chronic NSAIDs, other antiplatelet agents or history of bleeding disorders;
  • Geri: Elderly patients may be at ↑ risk of bleeding;
  • OB: use during pregnancy only if potential matenral benefit to justifies potential risk to the fetus;
  • Pedi: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Hemat: BLEEDING

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Drug-Natural Products:

Blood levels and effectiveness may be ↓ by St. John's wort ; concurrent use should be avoided.

Route/Dosage

PO: (Adults) 2.08 mg (one tablet) once daily.

Availability

Tablets: 2.08 mg

Assessment

  • Assess for signs and symptoms of bleeding periodically during therapy.

Potential Diagnoses

Implementation

  • PO: Administer once daily without regard to food.
    • Administer with aspirin or clopidogrel according to directions.

Patient/Family Teaching

  • Instruct patient to take vorapaxar as directed. Do not stop therapy without consulting health care professional. Advise patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
  • Caution patient to notify health care professional immediately if signs and symptoms of bleeding (bleeding that is severe or cannot be controlled, pink, red, or brown urine, vomiting blood or coffee ground-like vomit, red or black, tar-like stools, coughing up blood or blood clots) occur.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

Decrease in cardiac events.

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Citation

Quiring, Courtney, et al. "Vorapaxar." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110196/all/vorapaxar.
Quiring C, Sanoski CA, Vallerand AH. Vorapaxar. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110196/all/vorapaxar. Accessed April 25, 2019.
Quiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Vorapaxar. In Davis's Drug Guide. Available from https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110196/all/vorapaxar
Quiring C, Sanoski CA, Vallerand AH. Vorapaxar [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 April 25]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110196/all/vorapaxar.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - vorapaxar ID - 110196 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110196/all/vorapaxar PB - F.A. Davis Company ET - 16 DB - Anesthesia Central DP - Unbound Medicine ER -