Amiodarone with Edoxaban Interaction Details
Brand Names Associated with Amiodarone
- Amiodarone
- Cordarone®
- Pacerone®
Brand Names Associated with Edoxaban
- Edoxaban
- Savaysa®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 27, 2024
Interaction Effect
Increased edoxaban exposure
Interaction Summary
Concomitant use of edoxaban (a P-gp substrate) and certain P-gp inhibitors (ie, verapamil, quinidine, azithromycin, clarithromycin, erythromycin, oral itraconazole, or oral ketoconazole) may increase edoxaban exposure in patients being treated with edoxaban for DVT or pulmonary embolism. No dosage adjustments are needed for concomitant use with these P-gp inhibitors in patients receiving edoxaban for nonvalvular atrial fibrillation; however, if treated for DVT or pulmonary embolism, the edoxaban dosage should be reduced to 30 mg orally once daily[1]. Additionally, edoxaban dosage reduction to 30 mg once daily is suggested if coadministered with dronedarone or cyclosporine (P-gp inhibitors). If coadministration with amiodarone (P-gp inhibitor) is required, administer cautiously with close monitoring [2].
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of edoxaban (a P-gp substrate) and certain P-gp inhibitors (ie, verapamil, quinidine, azithromycin, clarithromycin, erythromycin, oral itraconazole, or oral ketoconazole) may increase edoxaban exposure. No dosage adjustments are needed for concomitant use with these P-gp inhibitors in patients receiving edoxaban for nonvalvular atrial fibrillation; however, if treated for DVT or pulmonary embolism, the edoxaban dosage should be reduced to 30 mg orally once daily[1]. Additionally, edoxaban dosage reduction to 30 mg once daily is suggested if coadministered with dronedarone or cyclosporine (P-gp inhibitors). If coadministration with amiodarone (P-gp inhibitor) is required, administer cautiously with close monitoring [2].
Mechanism Of Interaction
Inhibition of P-gp-mediated edoxaban transport
Literature Reports
A) Coadministration of P-gp inhibitors including amiodarone, dronedarone, quinidine, verapamil, and cyclosporine increased the AUC of edoxaban by 40%, 85%, 77%, 53%, and 73%, respectively [2].
References
1 ) Product Information: SAVAYSA(R) oral tablets, edoxaban oral tablets. Daiichi Sankyo Inc (per FDA), Basking Ridge, NJ, 2023.
2 ) Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
Amiodarone Overview
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Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.
Edoxaban Overview
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Edoxaban is used help prevent strokes or blood clots in people who have atrial fibrillation (a condition in which the heart beats irregularly, increasing the chance of clots forming in the body and possibly causing strokes) that is not caused by heart valve disease. Edoxaban is also used to prevent deep vein thrombosis (DVT; a blood clot, usually in the leg) and pulmonary embolism (PE; a blood clot in the lung) in people who have been treated with an injectable blood thinner medicine for 5 to 10 days. Edoxaban is in a class of medications called factor Xa inhibitors. It works by blocking the action of a certain natural substance that helps blood clots to form.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.