Names and pronunciation
(vor′a-pax′ar) Zontivity
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Drug reference
(vor′a-pax′ar) Zontivity
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Func. class.: Platelet aggregation inhibitor
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ACTION: Antagonizes the protease- activated receptor-1 (PAR-1) expressed on platelets V
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USES: Secondary myocardial infarction prophylaxis or stroke prophylaxis or thrombosis prophylaxis for reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction or with peripheral arterial disease
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CONTRAINDICATIONS
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Black Box Warning: Bleeding, intracra nial bleeding, stroke Precautions: Breastfeeding, coronary artery bypass graft surgery (CABG), geri atric patients, hepatic disease, labor, obstetric delivery, pregnancy, renal impairment, surgery Black Box Warning: For bleeding, in tracranial bleeding/stroke during treat ment; bleeding should be suspected in hypotension in those who have recently undergone surgery, coronary angiogra phy, (PCI), CABG; avoid products that in crease bleeding risk (salicylates, NSAIDs, SSRIs, SNRIs); avoid use in liver failure • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; do not breastfeed, excretion unknown
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SIDE EFFECTS HEMA: Bleeding CNS: Depression, intracranial bleeding EENT: Retinal changes, diplopia, epistaxis INTEG: Rash GI: GI bleed, melena GU: Hematuria, rectal hemorrhage
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INTERACTIONS Increase: bleeding risk—anticoagulants, aspirin, NSAIDs, other platelet inhibitors, SSRIs, rifampin, SNRIs, thrombolytics, ethyl estradiol, calcium channel blockers Decrease: vorapaxar effect—CYP3A induc ers (carBAMazepine, phenytoin, rifAMPin) Increase: vorapaxor effect—CYP3A4 inhibitors (clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saqui navir, telepravir) Drug/Herb Decrease: vorapaxar level—St. John’s wort; avoid concurrent use
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DOSAGE AND ROUTES • Adult: PO 2.08 mg once daily with aspirin and/or clopidogrel
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Available forms: Tab 2.08 mg
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Administer: • May be administered without regard to food • May be given with clopidogrel in ad dition to ASA • Give missed dose as soon as possible unless almost time for next scheduled dose, do not double
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Assess:
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Evaluate: • Therapeutic response: absence of MI, stroke
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any unusual bruising, bleeding to prescriber; that it may take longer to stop bleeding; that no true antidote exists and that there is an in creased bleeding risk for 4 wk after last dose • To take without regard to food • To inform all providers that this prod uct is being used; not to use OTC, pre scription, or herbal products without approval of prescriber • Not to breastfeed; to report if preg- nancy is planned or suspected • To take as prescribed with aspirin or clopidogrel; not to use alone; not to discontinue without prescriber ap proval
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PHARMACOKINETICS Within 1 week of treatment reaches ≥80% inhibition of thrombin receptor, half-life is 8 days, protein binding 99%, primarily eliminated feces; peak 1 hr
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• Adult: PO 2.08 mg once daily with aspirin and/or clopidogrel
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