betrixaban (Rx)

Brand and Other Names:Bevyxxa
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 40mg
  • 80mg

Venous Thromboembolism Prevention

Patients hospitalized for acute medical illness at risk for thromboembolic complications

Moderate or severe restricted mobility and other risk factors for VTE: 160 mg PO once initially, THEN 80 mg PO qDay

Recommended duration of treatment: 35-42 days

Dosage Modifications

Coadministration with P-gp inhibitors

  • Initial single dose of 80 mg, then 40 mg PO qDay x35-42 days
  • Patients taking P-gp inhibitor who also have severe renal impairment: Not recommended

Renal impairment

  • Mild-to-moderate (CrCl >30 mL/min): No dose adjustment needed
  • Severe (CrCl ≥15 to <30 mL/min): Initial single dose of 80 mg, then 40 mg PO qDay x35-42 days

Hepatic impairment

  • Mild: No dose adjustment required
  • Moderate-to-severe: Avoid use; these patients may have intrinsic coagulation abnormalities

Dosing Considerations

Limitations of use

  • Safety and efficacy not established for patients with prosthetic heart valves (not studied)

Safety and efficacy not established

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Interactions

Interaction Checker

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            Contraindicated (2)

            • apixaban

              apixaban, betrixaban. Either increases levels of the other by anticoagulation. Contraindicated. Therapeutic duplication; may use temporarily when switching anticoagulants.

            • rivaroxaban

              rivaroxaban, betrixaban. Either increases levels of the other by anticoagulation. Contraindicated. Therapeutic duplication; may use temporarily when switching anticoagulants.

            Serious - Use Alternative (6)

            • edoxaban

              edoxaban, betrixaban. Either increases levels of the other by anticoagulation. Contraindicated. Therapeutic duplication; may use temporarily when switching anticoagulants.

            • erdafitinib

              erdafitinib will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

            • fondaparinux

              fondaparinux, betrixaban. Either increases levels of the other by anticoagulation. Contraindicated. Therapeutic duplication; may use temporarily when switching anticoagulants.

            • lasmiditan

              lasmiditan increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • sotorasib

              sotorasib will decrease the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

            • tepotinib

              tepotinib will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

            Monitor Closely (133)

            • abciximab

              abciximab, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • abiraterone

              abiraterone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • afatinib

              afatinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • amiodarone

              amiodarone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • anagrelide

              anagrelide, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • antithrombin alfa

              antithrombin alfa, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • antithrombin III

              antithrombin III, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • argatroban

              argatroban, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • aspirin

              aspirin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • aspirin rectal

              aspirin rectal, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • atorvastatin

              atorvastatin increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • azithromycin

              azithromycin increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • berotralstat

              berotralstat will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

            • bivalirudin

              bivalirudin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • bosutinib

              bosutinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • canagliflozin

              canagliflozin increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • caplacizumab

              caplacizumab, betrixaban. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • carvedilol

              carvedilol increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • celecoxib

              celecoxib, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • cilostazol

              cilostazol, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • citalopram

              citalopram, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • clarithromycin

              clarithromycin increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • clopidogrel

              clopidogrel, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • cobicistat

              cobicistat increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • crizotinib

              crizotinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • cyclosporine

              cyclosporine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • dabigatran

              dabigatran, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • dalteparin

              dalteparin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • darunavir

              darunavir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • desirudin

              desirudin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • diclofenac

              diclofenac, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • diflunisal

              diflunisal, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • dipyridamole

              dipyridamole increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

              dipyridamole, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • dronedarone

              dronedarone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • elagolix

              elagolix will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • eliglustat

              eliglustat increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • enoxaparin

              enoxaparin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • eptifibatide

              eptifibatide, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • erythromycin base

              erythromycin base increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • erythromycin lactobionate

              erythromycin lactobionate increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • erythromycin stearate

              erythromycin stearate increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • escitalopram

              escitalopram, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • etodolac

              etodolac, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • etravirine

              etravirine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • everolimus

              everolimus increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • fenoprofen

              fenoprofen, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • fish oil

              fish oil, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of betrixaban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • flibanserin

              flibanserin increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • fluoxetine

              fluoxetine increases effects of betrixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • flurbiprofen

              flurbiprofen, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine, betrixaban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor.

            • fostamatinib

              fostamatinib will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

            • garlic

              garlic, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • grapefruit

              grapefruit increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • heparin

              heparin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • ibrutinib

              ibrutinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

              ibrutinib will increase the level or effect of betrixaban by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • ibuprofen

              ibuprofen, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • ibuprofen IV

              ibuprofen IV, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • indomethacin

              indomethacin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • isavuconazonium sulfate

              isavuconazonium sulfate increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • istradefylline

              istradefylline will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

            • itraconazole

              itraconazole increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ivacaftor

              ivacaftor increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

            • ketoconazole

              ketoconazole increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ketoprofen

              ketoprofen, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • ketorolac

              ketorolac, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • ketorolac intranasal

              ketorolac intranasal, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • lapatinib

              lapatinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ledipasvir/sofosbuvir

              ledipasvir/sofosbuvir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • lomitapide

              lomitapide increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • lonafarnib

              lonafarnib will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

            • lopinavir

              lopinavir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • meclofenamate

              meclofenamate, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • mefenamic acid

              mefenamic acid, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • mefloquine

              mefloquine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • meloxicam

              meloxicam, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • nabumetone

              nabumetone, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • naproxen

              naproxen, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • nelfinavir

              nelfinavir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • netupitant/palonosetron

              netupitant/palonosetron increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • nicardipine

              nicardipine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • nifedipine

              nifedipine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • nilotinib

              nilotinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ombitasvir/paritaprevir/ritonavir & dasabuvir

              ombitasvir/paritaprevir/ritonavir & dasabuvir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • omega 3 fatty acids

              omega 3 fatty acids, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • oxaprozin

              oxaprozin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • paliperidone

              paliperidone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • paroxetine

              paroxetine, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • pentostatin

              pentostatin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • piroxicam

              piroxicam, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • ponatinib

              ponatinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • posaconazole

              posaconazole increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • prasugrel

              prasugrel, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • progesterone micronized

              progesterone micronized increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • progesterone, natural

              progesterone, natural increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • propafenone

              propafenone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • propranolol

              propranolol increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • protein C concentrate

              protein C concentrate, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • quinidine

              quinidine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • quinine

              quinine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ranolazine

              ranolazine increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ritonavir

              ritonavir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • salsalate

              salsalate, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • sapropterin

              sapropterin increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • saquinavir

              saquinavir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • sarecycline

              sarecycline will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

            • sertraline

              sertraline, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • sofosbuvir/velpatasvir

              sofosbuvir/velpatasvir increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • stiripentol

              stiripentol will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

            • sulindac

              sulindac, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • sunitinib

              sunitinib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • suvorexant

              suvorexant increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • tacrolimus

              tacrolimus increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ticagrelor

              ticagrelor increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • ticlopidine

              ticlopidine, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • tirofiban

              tirofiban, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • tolmetin

              tolmetin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • tucatinib

              tucatinib will increase the level or effect of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

            • ulipristal

              ulipristal increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • vandetanib

              vandetanib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • vemurafenib

              vemurafenib increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • venetoclax

              venetoclax increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • verapamil

              verapamil increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            • vilazodone

              vilazodone, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • vitamin E

              vitamin E, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • vortioxetine

              vortioxetine, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • warfarin

              warfarin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • zanubrutinib

              betrixaban, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            • zonisamide

              zonisamide increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

            Minor (0)

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              Adverse Effects

              1-10%

              Clinically relevant nonmajor bleeding (2.45%)

              Epistaxis (2%)

              Hematuria (2%)

              <1%

              Bleeding

              • Major bleeding (0.67%)
              • GI bleeding (0.51%)
              • Intracranial hemorrhage (0.05%)
              • Fatal bleeding (0.03%)

              Postmarketing Reports

              Increased risk of thrombosis in patients with triple-positive antiphospholipid syndrome

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              Warnings

              Black Box Warnings

              Spinal/epidural hematoma

              • Epidural or spinal hematomas may occur in patients who are receiving neuraxial anesthesia or undergoing spinal puncture
              • These hematomas may result in long-term or permanent paralysis
              • Monitor patients frequently for signs and symptoms of neurological impairment (eg, numbness or weakness of legs, bowel, or bladder); if neurological compromise is noted, urgent treatment is necessary
              • Consider the benefits and risks before neuraxial intervention in patients who are anticoagulated or to be anticoagulated
              • Management
                • Do not remove an epidural catheter earlier than 72 hr after the last administration of betrixaban
                • Do not administer the next betrixaban dose earlier than 5 hr after catheter removal
                • If traumatic puncture occurs, delay administering betrixaban for 72 hr
              • Factors that can increase the risk include
                • Use of indwelling epidural catheters
                • Concomitant use of other drugs that affect hemostasis (eg, NSAIDs, platelet inhibitors, other anticoagulants)
                • History of traumatic or repeated epidural or spinal punctures
                • History of spinal deformity or spinal surgery
                • Optimal timing between the administration of drug and neuraxial procedures is not known

              Contraindications

              Active pathological bleeding

              Severe hypersensitivity

              Cautions

              Increases bleeding risk and can cause serious and potentially fatal bleeding; promptly evaluate any signs or symptoms of blood loss; there is no established way to reverse betrixaban’s anticoagulant effect, which can persist for at least 72 hr after the last dose; protamine, vitamin K, and tranexamic acid are not expected to reverse betrixaban anticoagulant activity

              Not recommended for use in patients with triple-positive antiphospholipid syndrome (APS); for patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardiolipin, and anti–beta 2- glycoprotein I antibodies]), treatment with direct-acting oral anticoagulants has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy

              Risk of paralysis with neuraxial anesthesia (see Black Box Warnings)

              Increased bleeding risk with severe renal impairment (see Dosage Modifications)

              Drug interaction overview

              • P-gp substrate
              • Reduce betrixaban dose if coadministration with P-gp inhibitors, owing to increased bleeding risk; avoid coadministration in patients with severe renal impairment receiving concomitant P-gp inhibitors
              • Avoid coadministration with P-gp inducers owing to potential for decreased systemic exposure and pharmacodynamic effects of betrixaban
              • Coadministration with drugs affecting hemostasis increases bleeding risk; examples include aspirin and other antiplatelet agents, other anticoagulants, heparin, thrombolytic agents, SSRIs, SNRIs, and NSAIDs
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              Pregnancy

              Pregnancy

              No data exist with use in pregnant women, but treatment is likely to increase risk of hemorrhage during pregnancy and delivery

              Use during pregnancy only if the potential benefit outweighs the potential risk to the mother and fetus

              Animal studies

              • Although betrixaban has not been associated with adverse developmental fetal outcomes in animals, maternal toxicity (ie, hemorrhage) was identified in these studies

              Lactation

              Unknown if distributed in human breast milk

              Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Oral factor Xa (FXa) inhibitor that selectively blocks the active site of FXa and does not require a cofactor (eg, antithrombin III) for activity; inhibits free FXa and prothrombinase activity

              By directly inhibiting FXa, betrixaban decreases thrombin generation

              Has no direct effect on platelet aggregation

              Blood coagulation cascade is dependent upon the activation of factor X to FXa via the intrinsic and extrinsic pathways, which play a central role in the blood coagulation cascade

              Absorption

              Bioavailability: 34%

              Peak plasma time: 3-4 hr

              Distribution

              Protein bound: 60%

              Vd: 32 L/kg

              Metabolism

              Unchanged betrixaban is the predominant component found in human plasma

              Two inactive major metabolites formed by CYP-independent hydrolysis comprise the other components in plasma, accounting for 15-18% of the circulating drug-related material

              Elimination

              Half-life: 19-27 hr

              Excretion: 85% feces; 11% urine

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              Administration

              Oral Administration

              Take with food at approximately the same time each day

              Missed dose: Take as soon as possible on the same day; do not double dosage to make up for a missed dose

              Storage

              Store at room temperature 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

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              Images

              No images available for this drug.
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.