Table 1. Anticoagulants for VTE-pharmacokinetics and drug interactions [10-12].
| Agent | Half Life Hours (h) | Time to Reach Cmax (h) | Mode of Excretion (Estimated Values) | Drug Interactions |
|---|---|---|---|---|
| Rivaroxaban | 5-9 11-13 in elderly |
2-4 | Renal scretion 36% Renal excretion of inactive metabolites 30% Total renal elimination 66% Fecal excretion 28% |
Not recommended to use with strong CYP3A4 and P-gp (P glycoprotein) inhibitors or inducers |
| Apixaban | 12 | 3-4 | Hepatobiliary excretion (major route) Renal scretion 27% |
Not recommended to use with strong CYP3A4 and P-gp inducers. May reduce apixaban dose from 5 mg to 2.5 mg twice daily with strong CYP3A4 and P-gp inhibitors. Avoid use with strong CYP3A4 and P-gp inhibitors if on apixaban 2.5 mg twice daily |
| Dabigatran | 12-17 | 1 h (fasting state); delayed by 2 h with high fat meal | Renal elimination 80% | Not recommended to use with strong P-gp inhibitors or inducers |
| Warfarin | 20-60 (mean 40) | Within 4 h | Eliminated by metabolism, mostly in the urine (92%) | Multiple interactions |
Cmax = Maximum concentration in plasma, h = Hour(s). Warfarin information accessed on Feb 28th 2015 from http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/009218s107lbl.pdf.