Names and pronunciation
(be-trix′-a-ban) Bevyxxa
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Drug reference
(be-trix′-a-ban) Bevyxxa
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Func. class.: Anticoagulant
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Chem. class.: Selective factor Xa inhibitor
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ACTION: Inhibits factor Xa; neutral- ization of factor Xa interrupts blood coagulation and thrombin formation
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USES: Prevention/treatment of deep venous thrombosis’ PE in at-risk, acutely ill, hospitalized medical patients
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CONTRAINDICATIONS: Hyper- sensitivity, active major bleeding Precautions: Pregnancy, breastfeeding, children, geriatric patients, hepatic dis- ease, renal disease
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Black Box Warning: Spinal/epidural an- esthesia, lumbar puncture Black Box Warning: Monitor patients who have received epidural/spinal anes- thesia or lumbar puncture for neurologic impairment, including spinal hematoma; may lead to permanent disability or pa- ralysis • Hepatic impairment: avoid use • Renal impairment: dose reduction is required • For bleeding: gums, petechiae, ecchy- mosis, black tarry stools, hematuria; de- creased Hct; notify prescriber • For risk of hemorrhage if coadminister- ing with other products that may cause bleeding • For hypersensitivity: rash, fever, chills; notify prescriber • Monitor QTc interval if needed in car- diac patients • Pregnancy/breastfeeding: consider risks of bleeding and stroke; use only if benefits outweigh risks; consider poten- tial adverse effects before breastfeeding • Beers: avoid in older adults; increased risk of bleeding, lower CCr Black Box Warning: Spinal/epidural he- matoma: in those that received spinal/ epidural anesthesia; weakness in lower extremities, bowel bladder involvement HIGH ALERT
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INTERACTIONS Increase: bleeding risk—salicylates, NSAIDs, abciximab, eptifibatide, tirofi- ban, clopidogrel, dipyridamole, quiNI- Dine, valproic acid, P-gp inhibitors Drug/Herb Increase: bleeding risk—feverfew, gar- lic, ginger, ginkgo, ginseng, green tea, horse chestnut, kava Drug/Lab Decrease: potassium
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DOSAGE AND ROUTES DVT prophylaxis, pulmonary embo- lism prophylaxis in at-risk, acutely ill, hospitalized medical patients • Adult: PO 160 mg once, followed by 80 mg/day for 35-42 days Renal dose Adult: PO CCr 15-<30 mL/min 80 mg, then 40 mg daily × 35-42 days Concomitant use of P-gp inhibitors: Reduce initial dose to 80 mg as a single dose, then 40 mg once daily for 35-42 days
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Available forms: Capsules 40, 80 mg
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Administer: • Give with food at same time of day • If a dose is missed, take as soon as remembered on the same day; do not double • Store at room temperature
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Assess:
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Evaluate: • Therapeutic response: prevention of DVT
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor • To report any signs of bleeding: gums, under skin, urine, stools; bleeding risk may continue up to 72 hr after stopping therapy • To avoid OTC products containing as- pirin, NSAIDs • To take with food
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PHARMACOKINETICS Onset unknown, peak 3-4 hr, duration >72 hr, protein binding 60%, half-life 19-27 hr; excreted in urine 11%, feces 85%
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• Adult: PO 160 mg once, followed by 80 mg/day for 35-42 days Renal dose Adult: PO CCr 15-<30 mL/min 80 mg, then 40 mg daily × 35-42 days Concomitant use of P-gp inhibitors: Reduce initial dose to 80 mg as a single dose, then 40 mg once daily for 35-42 days
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