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# Vorapaxar (Zontivity) ## Overview Vorapaxar is a protease-activated receptor-1 (PAR-1) antagonist, which is a receptor on platelets. It inhibits thrombin-induced platelet aggregation. It is a platelet inhibitor. ## Primary Indications Vorapaxar is indicated to reduce thrombotic cardiovascular events in patients with a history of myocardial infarction (MI) or with established peripheral arterial disease (PAD). ## Adult Dosing The recommended dose of vorapaxar is 2.5 mg orally once daily. ## Pediatric Dosing Dosing for pediatric patients has not been established. ## Dose Adjustments No dose adjustments are necessary for patients with hepatic impairment or renal impairment. ## Contraindications * Active serious bleeding (e.g., intracranial hemorrhage, gastrointestinal bleeding). * History of transient ischemic attack (TIA) or stroke. * Hypersensitivity to vorapaxar or any component of the formulation. ## Adverse Effects The most common adverse effects include bleeding (bruising, epistaxis, gastrointestinal bleeding, hematuria), and rash. More serious bleeding events can occur. ## Key Drug Interactions * **Strong CYP2J2 inhibitors:** Vorapaxar is a substrate of CYP2J2. Coadministration with strong CYP2J2 inhibitors may increase vorapaxar plasma concentrations. (Specific drug examples not listed, but generally includes certain macrolides and antifungals). * **Antiplatelet agents and anticoagulants:** Concurrent use increases the risk of bleeding. Careful monitoring is required. ## Monitoring * Monitor for signs and symptoms of bleeding. * Discontinuation of vorapaxar before surgery should be based on clinical judgment and the specific procedure. ## Clinical Pearls * Vorapaxar is an *orally active, reversible antagonist* that is administered as a single daily dose. * It should be used in patients who are *not at high risk for bleeding*. * Vorapaxar should be *discontinued* in patients who have had a TIA or stroke. * There is no specific antidote for vorapaxar. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and relevant guidelines before making any clinical decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*