Hospital Pharmacy - April 2012 - (Page 293)

Hosp Pharm 2012;47(4):293–302, 320 2012 Ó Thomas Land Publishers, Inc. www.thomasland.com doi: 10.1310/hpj4704-293 Formulary Drug Reviews Rivaroxaban in Nonvalvular Atrial Fibrillation Dennis J. Cada, PharmD, FASHP, FASCP (Editor)p; Terri L. Levien, PharmD†; and Danial E. Baker, PharmD, FASHP, FASCP‡ Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The April 2012 monograph topics are on ivacaftor, vismodegib, axitinib, glucarpidase, and loxapine inhalation. The DUE/MUE is on glucarpidase. Generic Name: Proprietary Name: Approval Rating: Therapeutic Class: Similar Drugs: Rivaroxaban Xarelto (Johnson & Johnson, Ortho-McNeil) 1S Hematological Agents, Direct Factor Xa Inhibitors Dabigatran, Fondaparinux, Heparin, Low-MolecularWeight Heparin, Warfarin Sound- or Look-Alike Names: Ribavirin, Rivastigmine INDICATIONS Rivaroxaban is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial ﬁbrillation and to prevent deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients undergoing hip or knee replacement surgery.1 The Formulary Monograph Service monograph on rivaroxaban published in September 2011 reviews rivaroxaban’s use for DVT prophylaxis. This monograph focuses on its use to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial ﬁbrillation. Warfarin and dabigatran are the US Food and Drug Administration (FDA)–approved agents currently recommended as ﬁrst-line agents for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial ﬁbrillation; clopidogrel plus aspirin or aspirin alone may also be considered.2,3 The FDAapproved indications for rivaroxaban, dabigatran, and warfarin are compared in Table 1. Rivaroxaban is undergoing evaluation for use in the treatment of venous thromboembolism and in the prevention of secondary events following acute coronary syndromes. CLINICAL PHARMACOLOGY Rivaroxaban is a novel oral anticoagulant that directly antagonizes factor Xa and is a reversible inhibitor of the factor Xa active site.6 Initially, the coagulation cascade is composed of 2 distinct *Executive Editor, The Formulary; †Clinical Associate Professor of Pharmacotherapy, Drug Information Center, Washington State University, Spokane, Washington; ‡Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy, Washington State University Spokane, PO Box 1495, Spokane, Washington 99210-1495. The authors indicate no relationships that could be perceived as a conﬂict of interest. Hospital Pharmacy 293 http://www.thomasland.com

Table of Contents for the Digital Edition of Hospital Pharmacy - April 2012

Hospital Pharmacy - April 2012
Editorial
ISMP Medication Error Report Analysis
ISMP Adverse Drug Reactions
Cancer Chemotherapy Update
Off-Label Drug Uses
Original Article
Symptomatic Bradycardia, Syncope, and Prolonged Qtc Interval Associated With Dronedarone Therapy
Extended Stability of Magnesium Sulfate Infusions Prepared in Polyolefin Bags
Formulary Drug Reviews
Continuing Education Case Study Quiz (0.15 CEU)
Current FDA-Related Drug Information
Pharmacy Automation and Technology
Director’s Forum
Hospital Pharmacy Pulse
Index to Advertisers

Hospital Pharmacy - April 2012