Home Drug Guide Vorapaxar Sulfate

Drug Guide

Generic Name

Vorapaxar Sulfate

Brand Names Zontivity

Classification

Therapeutic: Antiplatelet agent

Pharmacological: Protease-activated receptor-1 antagonist

FDA Approved Indications

  • Secondary prevention of thrombotic cardiovascular events in patients with a history of myocardial infarction or peripheral arterial disease

Mechanism of Action

Vorapaxar is a selective antagonist of protease-activated receptor-1 (PAR-1), blocking thrombin-induced and collagen-induced platelet aggregation, thus reducing clot formation.

Dosage and Administration

Adult: Hemorrhage risk dictates initial dose of 2.08 mg (stronger loading dose), followed by a maintenance dose of 2.08 mg once daily. Importantly, it should be used in conjunction with aspirin or other antiplatelet therapy.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; no specific dose adjustment, but increased bleeding risk requires careful assessment.

Renal Impairment: No specific dose adjustment indicated, but caution is advised.

Hepatic Impairment: No specific dose adjustment; use with caution.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration.

Distribution: Widely distributed; volume of distribution approximately 130 liters.

Metabolism: Metabolized primarily via CYP3A4/5 enzymes.

Excretion: Primarily excreted in feces, with minimal urinary excretion.

Half Life: Approximately 20 hours.

Contraindications

  • Active pathological bleeding
  • History of hemorrhagic stroke

Precautions

  • Use with caution in patients with increased risk of bleeding, recent surgery, or trauma; monitor for signs of bleeding.

Adverse Reactions - Common

  • Bleeding (e.g., hematoma, hemorrhage) (Common)

Adverse Reactions - Serious

  • Major bleeding, including intracranial hemorrhage (Less common but serious)

Drug-Drug Interactions

  • Other anticoagulants or antiplatelet agents (e.g., aspirin, clopidogrel) may increase bleeding risk.

Drug-Food Interactions

  • No significant interactions identified.

Drug-Herb Interactions

  • Limited data; avoid complementary herbs with bleeding risk (e.g., ginkgo, ginseng).

Nursing Implications

Assessment: Monitor for signs of bleeding, perform platelet counts, and assess bleeding risk before and throughout therapy.

Diagnoses:

  • Risk for bleeding
  • Impaired tissue perfusion

Implementation: Administer as prescribed, monitor bleeding, educate patient on signs of bleeding.

Evaluation: Effectiveness in preventing thrombotic events; absence of bleeding episodes.

Patient/Family Teaching

  • Report any unusual bleeding, bruising, or signs of hemorrhage.
  • Avoid activities that may cause injury or bleeding.
  • Inform healthcare providers of all medications and supplements.

Special Considerations

Black Box Warnings:

  • Bleeding risk is increased; contraindicated in certain bleeding disorders.
  • Caution in use in patients with a history of stroke or intracranial hemorrhage.

Genetic Factors: Genetic variations affecting CYP3A4 may influence metabolism.

Lab Test Interference: May affect coagulation tests; interpret with caution.

Overdose Management

Signs/Symptoms: Excessive bleeding, hematoma, petechiae.

Treatment: Discontinue drug immediately; provide supportive care; consider blood products or agents to reverse bleeding if necessary.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended storage conditions, consult package insert for expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.