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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

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In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

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Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Dosage Regimens: Partial Pharmacokinetic Parameters01:01

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It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...
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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
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Nomograms and tabulations are vital tools used by clinicians to design accurate and individualized dosage regimens. These instruments provide a straightforward method for adjusting dosages based on individual patient characteristics, including age, weight, and physiological condition. The foundation of a drug's nomogram is population pharmacokinetic data collected and analyzed using specific models. This data simplifies complex equations, presenting them diagrammatically or tabularly for easy...
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Critical Analysis of Apixaban Dose Adjustment Criteria.

Anh Vu1, Tao T Qu1, Rachel Ryu2

  • 1Department of Pharmacy Practice, Loma Linda University School of Pharmacy, CA, USA.

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|June 2, 2021
PubMed
Summary

Apixaban dose adjustments for non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE) may require re-evaluation. Clinical data suggest current criteria may not impact apixaban safety or efficacy in specific patient groups.

Keywords:
anticoagulationapixabandosing

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Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Drug Safety

Background:

  • Apixaban is prescribed for non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE).
  • Dosing adjustments for apixaban in NVAF are based on age, weight, and renal function, unlike VTE treatment.
  • These adjustment criteria are unconventional compared to other anticoagulants.

Purpose of the Study:

  • To critically analyze apixaban dosing adjustment criteria.
  • To evaluate the outcomes associated with apixaban dose adjustments.

Main Methods:

  • Literature search of PubMed from March 2013 to March 2020.
  • Keywords: "apixaban," "dose adjustment," "adjustment," "adjustment criteria."
  • Analysis of pharmacokinetic and clinical data.

Main Results:

  • Pharmacokinetic studies indicate higher apixaban exposure in elderly patients (>65 years), those with extreme body weights, and impaired renal function.
  • Clinical data reveal no compromise in apixaban safety or efficacy for patients >75 years, <60 kg, or with eGFR <50 mL/min, including those on dialysis.
  • Variable dosing strategies are observed in clinical practice.

Conclusions:

  • Current apixaban dose adjustment criteria may warrant re-evaluation.
  • Clinical evidence suggests potential for revised dosing guidelines.
  • Further research into apixaban dosing optimization is recommended.