Switch to Edoxaban from Apixaban for patients with AF

Edoxaban is currently the preferred DOAC to use for Non-valvular Atrial Fibrillation (NV-AF).

Edoxaban is the preferred anticoagulant locally. Using edoxaban instead of other anticoagulants will help your local NHS to treat more patients. This is because two patients can be treated with edoxaban in comparison to one patient treated with another anticoagulant.

Consider edoxaban, if clinically appropriate, as an alternative for existing NV-AF patients prescribed rivaroxaban, apixaban, dabigatran or warfarin

Costs

TWO patients can be treated with edoxaban in comparison to ONE patient with either apixaban, dabigatran or rivaroxaban.

Patient Information Leaflet & Alert Card

When switching patients to edoxaban, ensure they receive the patient information leaflet, alongside the manufacturer’s alert card and leaflet that they will receive with their edoxaban tablets pack.

Edoxaban is taken ONCE a day and can be taken with or without food, swallowing the whole tablet, preferably with water. Try to take your Edoxaban regularly at the same time each day, and continue to do so unless your doctor tells you to stop. If you have difficulty swallowing the tablet whole, talk to a doctor or pharmacist about other ways to take Edoxaban.

Patient leaflet Edoxaban

Instructions for switching

• If patients meet the criteria for switching and have agreed to the switch, they should be issued with a prescription for edoxaban; see dosing and monitoring advice below and in SmPC
• They should be advised to use up the supply of existing DOAC before switching to edoxaban. They should switch to edoxaban the day after they use up their existing supply.
• If they are switching from apixaban they should take both the morning and evening dose on the day before switching to edoxaban. Further details on switching in local AF guidelines
• Edoxaban should be taken once daily. The precise time of day is not important, neither is the timing in relation to food. The patient should decide the most convenient time of day for them. It is important to take edoxaban every day
• Normal dose 60mg od
• If renal function decreases significantly then the DOAC dose may need to be reviewed.
  • For edoxaban the important value for review of treatment is 50ml/min which should trigger a dose reduction to 30mg once daily SmPC
  • Edoxaban, and other DOACs are not recommended if the creatinine clearance is <15ml/min. These patients should receive warfarin if there is a clinical indication for long-term anticoagulation

Read Code

Add Read code (8B316) or SnoMed code (182838006) for medication changed.