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Rivaroxaban marketing time: Rivaroxaban was approved for marketing in Canada and the European Union on September 15 and October 1, 2008 respectively. On July 1, 2011, the FDA approved the drug for the prevention of deep vein thrombosis in patients undergoing knee or hip replacement surgery.

Rivaroxaban, sold under the trade names Xarelto and others, is an anticoagulant drug (blood thinner) used to treat and prevent blood clots. It is used to treat deep vein thrombosis and pulmonary embolism, and to prevent blood clots in atrial fibrillation and after hip or knee surgery. Rivaroxaban can interrupt the intrinsic and extrinsic pathways of the coagulation cascade by inhibiting factor xa, inhibiting thrombin generation and thrombosis. Rivaroxaban does not inhibit thrombin and has no proven effect on platelets. A dose-dependent inhibition of factor xa activity by rivaroxaban has been observed in humans.

Drug interactions of rivaroxaban: 1. It is not recommended to co-administer rivaroxaban with azole-antifungal agents (such as ketoconazole, itraconazole, voriconazole and posaconazole) or systemic HIV protease inhibitors. 2. Enoxaparin does not affect the pharmacokinetics of rivaroxaban. Particular caution should be exercised if patients are concurrently receiving any other anticoagulants due to an increased risk of bleeding. 3. NSAIDs/Platelet Aggregation Inhibitors No clinically significant prolongation of bleeding time was observed when rivaroxaban was combined with 500 mg naproxen. 4. The combination of CYP3A4 inducer rivaroxaban and the potent CYP3A4 inducer rifampicin will reduce the average AUC of rivaroxaban by about 50%, and the drug efficacy will also decrease in parallel. Coadministration of rivaroxaban with other strong CYP3A4 inducers (such as phenytoin, carbamazepine, phenobarbital, or St. John's wort) may also decrease rivaroxaban plasma concentrations. Caution should be used when coadministering strong CYP3A4 inducers.