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# Vorapaxar (Zontivity)
## Overview
Vorapaxar is a platelet aggregation inhibitor that selectively and reversibly antagonizes the protease-activated receptor-1 (PAR-1).
## Primary Indications
* As an adjunct to aspirin and/or clopidogrel in patients with a history of myocardial infarction (MI) or with established peripheral arterial disease (PAD) to reduce the risk of thrombotic cardiovascular events.
## Adult Dosing
* The recommended dose is 2.5 mg orally once daily.
* Vorapaxar should be taken at the same time each day.
## Pediatric Dosing
* Safety and efficacy in pediatric patients have not been established.
## Dose Adjustments
* No dose adjustment is required for patients with mild to severe renal impairment.
* No dose adjustment is required for patients with mild to moderate hepatic impairment.
* Vorapaxar is not recommended in patients with severe hepatic impairment.
## Contraindications
* Active serious bleeding (e.g., intracranial hemorrhage, gastrointestinal bleeding).
* History of transient ischemic attack (TIA), stroke, or intracranial hemorrhage.
* Known hypersensitivity to vorapaxar or any of its excipients.
## Adverse Effects
* The most common adverse reactions include bleeding (e.g., gastrointestinal, bruising), rash, and dyspnea.
* Serious bleeding events, including fatal bleeding, can occur.
## Key Drug Interactions
* **Antiplatelets and Anticoagulants:** Concomitant use with other drugs that affect hemostasis (e.g., aspirin, clopidogrel, heparin, warfarin, other P2Y12 inhibitors, NSAIDs) increases the risk of bleeding.
* **CYP2A6 Inhibitors:** Drugs that inhibit CYP2A6 (e.g., fluvoxamine) may increase vorapaxar exposure.
* **CYP2A6 Inducers:** Drugs that induce CYP2A6 may decrease vorapaxar exposure.
## Monitoring
* Monitor for signs and symptoms of bleeding.
* Consider discontinuation in patients experiencing serious bleeding or other complications.
## Clinical Pearls
* Vorapaxar is generally not recommended for patients with a history of TIA or stroke due to an increased risk of intracranial hemorrhage.
* Discontinue vorapaxar at least 7 days prior to elective surgery if possible, considering the increased risk of bleeding.
* Vorapaxar has a long half-life, and its antiplatelet effect persists for several weeks after discontinuation.
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**Disclaimer:** This information is intended for clinical professionals and does not replace comprehensive prescribing information. Always consult the most current official prescribing information and institutional guidelines before making any clinical decisions.
