Bevyxxa
Bevyxxa (betrixaban) is an oral anticoagulant (blood thinner) that is used to prevent blood clots in people who have been hospitalized and are at risk for developing blood clots. It can raise your risk for serious life-threatening bleeding. Bevyxxa (betrixaban) was discontinued by the manufacturer in April 2020 due to business reasons.
What is Bevyxxa (betrixaban)?
What is Bevyxxa (betrixaban) used for?
- Blood clot prevention in people who have been hospitalized
How Bevyxxa (betrixaban) works
Bevyxxa (betrixaban) is an anticoagulant (blood thinner) that works by stopping factor Xa, a protein that’s involved in the blood clotting process. When this protein is blocked, blood clots are less likely to form in your body.
Drug facts
Side effects of Bevyxxa (betrixaban)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Urinary tract infection (3%)
- Low potassium (3%)
- Constipation (3%)
- Diarrhea (2%)
- Nosebleed (2%)
- Blood in the urine (2%)
- Headache (2%)
- Nausea (2%)
- High blood pressure (2%)
Less Common Side Effects
- Stomach bleed
- Brain bleed
- Eye bleed
Bevyxxa (betrixaban) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious bleeding: black, red, or tarry stools, vomiting blood, unexplained bruises, bruises that get bigger, bleeding that won’t stop
- Bleeding around the spine (spinal or epidural hematoma): back pain, weakness, difficulty walking, loss of bowel or bladder control, paralysis
Pros and cons of Bevyxxa (betrixaban)
Pros
- Does not need routine blood monitoring like warfarin
- Only needs to be taken once a day, whereas some other oral anticoagulants such as Eliquis (apixaban) are used twice daily
- Available as an oral capsule, unlike other injectable anticoagulants, such as enoxaparin (Lovenox) or heparin
- Available in 2 different strengths
Cons
- Recently discontinued by the manufacturer in 2020
- Can only be used for people who have been hospitalized
- No generic available, so it is very expensive
- Can cause you to bruise more easily. Minor cuts to the skin can take longer to stop bleeding.
- No FDA approved way to quickly stop the effects of the medication in cases of a life-threatening bleed
Pharmacist tips for Bevyxxa (betrixaban)
- Bevyxxa (betrixaban) makes blood clots less likely to form, which means it will make you bleed easier. Watch out for signs of bleeding like black, red, or tarry stools, vomiting blood, unexplained bruises or bruises that get bigger, or bleeding that won’t stop.
- Let your provider know right away if you fall and hit your head, especially if you are dizzy or have a headache. This could be a sign of bleeding in your brain and needs to be addressed immediately.
- If you are going to have surgery or a dental procedure, it is important to tell your provider that you are taking Bevyxxa (betrixaban). You might have to stop this medication a few days before your procedure to prevent a serious bleed during the procedure.
- Bevyxxa (betrixaban) should be taken with food so that your body doesn’t absorb too much of the medication. This lowers the risk of serious side effects, such as life-threatening bleeding.
- Bevyxxa (betrixaban) interacts with many common over-the-counter (OTC) products such as medications that are used for pain and herbal supplements. Talk to your provider or pharmacist before starting any new medications or supplements.
- There is no FDA-approved way to reverse the effects of Bevyxxa (betrixaban) in an emergency bleeding situation. It is important that all of your providers or emergency personnel know you are taking this medication in case of an emergency.
- It is important to take Bevyxxa (betrixaban) at the same time every day. If you forget to take a dose at your usual time, take the dose as soon as possible on the same day. Never take two doses to make up for a missed dose because it increases your risk of having a life-threatening bleed.
Common questions about Bevyxxa
Because Bevyxxa can cause bleeding, you should avoid all over-the-counter NSAID (nonsteroidal anti-inflammatory drug) products, such as ibuprofen (Advil), naproxen (Aleve), and aspirin. These medications raise your risk of having a serious bleed. You should also avoid an herbal supplement known as St. John's wort. This supplement lowers the amount of Bevyxxa in your body, which causes Bevyxxa to not work as well. Talk to your provider or pharmacist before starting any new medication to make sure there are no dangerous interactions.
When Bevyxxa is taken with food, less of the medication is absorbed and it does not reach as high of a level in your body compared to taking it on an empty stomach. This lowers your chances of serious side effects like life-threatening bleeding.
People who are not able to move while in the hospital are at a higher risk of getting blood clots. These blood clots can form in the legs, groin, or arm. Some of these blood clots may even travel from those areas into the lungs. This can stop oxygen from flowing properly through the blood in your body, which can be deadly. Bevyxxa stops a protein in your blood from working, which helps prevent blood clots from forming.
Currently, there is no FDA-approved treatment to stop or reverse the effects of Bevyxxa in case you have a serious bleed that needs to be stopped immediately. Other blood thinners have reversal agents to help stop or reverse the effects of the medication. For example, a medication called Andexxa (andexanet alfa) can reverse the effects of Eliquis (apixaban) and Xarelto (rivaroxaban).
Bevyxxa was discontinued and taken off the market in April 2020. It was removed from the market by the manufacturer, Portola, for business reasons. The medication was not discontinued due to safety reasons.
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Risks and warnings for Bevyxxa (betrixaban)
Bevyxxa (betrixaban) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Paralysis in the spine
- Risk factors: Using other blood thinners or NSAIDs | History of spinal surgery or spinal tap | Use of in-dwelling epidural catheter | Anesthesia in the spine (epidural)
Taking Bevyxxa (betrixaban) puts you at a greater risk for bleeding around the spine, which can leave you paralyzed. This risk is even greater before a spinal surgery, including spinal taps or epidurals. If you are going to have a spinal tap or epidural, your provider will tell you how to safely stop Bevyxxa (betrixaban) before your procedure to lower the risk of a spinal bleed. Call your provider immediately if you notice any signs or symptoms of a spinal bleed, such as back pain, weakness, numbness, difficulty walking, or a loss of bowel or bladder control.
Serious bleed
- Risk factors: Taking other blood thinners or NSAIDs | Taking selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) | Severe kidney damage | Taking medications that are P-gp inhibitors
Taking Bevyxxa (betrixaban) puts you at risk of having a major life-threatening bleed. This risk is greater in people taking other medications that can also cause bleeding, such as: other blood thinners or NSAIDs like ibuprofen (Advil) or naproxen (Aleve); SSRIs, like escitalopram (Lexapro) or sertraline (Zoloft); and SNRIs like venlafaxine (Effexor).
Bleeding is more likely to happen in people with severe kidney damage, so the dose will be lowered to reduce the risk for bleeds. In addition, people taking medications that are considered to be P-glycoprotein inhibitors, such as azithromycin, clarithromycin, ketoconazole, amiodarone, and verapamil also start with a lower dose because they have a greater risk for bleeding. This is because these medications can raise the levels of Bevyxxa (betrixaban) in your body. Tell your provider immediately if you notice black, red, or tarry stools, blood in your vomit, unexplained bruises or bruises that get bigger, or bleeding that won’t stop.
Higher risk of blood clots in people with APS (antiphospholipid syndrome)
People with APS are more likely to have recurrent blood clots when taking Bevyxxa (betrixaban) compared to people taking warfarin (Coumadin). This is especially true for people with triple-positive APS. Bevyxxa (betrixaban) should be avoided in people with APS to help prevent blood clots from occurring again.
Bevyxxa (betrixaban) dosage
Typical dosage for Bevyxxa (betrixaban)
Bevyxxa (betrixaban) is usually taken as a single dose of 160 mg by mouth, followed by 80 mg once daily for 35 to 42 days. It should be taken with food.
Your dose might be lower if you have kidney problems or are taking medications that are Pgp (P-glycoprotein) inhibitors, such as azithromycin (Zithromax), clarithromycin (Biaxin), ketoconazole, verapamil (Calan), and amiodarone.
Bevyxxa (betrixaban) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Bevyxxa (betrixaban) will not be safe for you to take.
- Active bleeding
