47
Factor Xa Inhibitor
Rivaroxaban Apixaban Edoxaban
CYP3A4/5 CYP3A4 Minimal CYP3A4
Yes Yes Yes
66% renal, 28% feces 27% renal, 73% biliary and
intestinal
50% renal, 50% liver
and biliary/intestinal
5–9 h 12 h 10–14 h
CrCl >50
mL/ min
20 mg daily
with the
biggest meal*
5 mg twice
daily
CrCl >50
to ≤95 mL/
min
60 mg
once
daily
CrCl
15–50
mL/min
15 mg daily
with the
biggest meal*
If any 2 of the
following :
age ≥80 y,
body weight
≤60 kg, SCr
≥1.5 mg/ dL
2.5 mg twice
daily
CrCl 15–50
mL/min
30 mg
once
daily
Avoid rivaroxaban use with
concomitant therapy of
combined p-glycoprotein
and strong CYP3A4
inhibitors (eg, systemic
ketoconazole and ritonavir)
No dose adjustment
required with
clarithromycin
Avoid rivaroxaban use in
patients with CrCl 15 to
< 80 mL/min receiving
combined p-glycoprotein
and moderate CYP3A4
inhibitors (eg,
erythromycin)
In patients receiving apixaban
5 mg twice daily, reduce dose
to 2.5 mg twice daily when
combined p-glycoprotein and
strong CYP3A4 inhibitors
(eg, itraconazole, systemic
ketoconazole, ritonavir) are
concomitantly used
If patients already receiving
apixaban 2.5 mg twice
daily, avoid apixaban use if
combined p-glycoprotein and
strong CYP3A4 inhibitors are
concomitantly used
No dose adjustment is
required
