{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:13:38Z","timestamp":1787166818094,"version":"build-2736575974"},"reference-count":68,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T00:00:00Z","timestamp":1609891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["accp1.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Clinical Pharma"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The non\u2013vitamin K antagonist oral anticoagulant rivaroxaban is used in several thromboembolic disorders. Rivaroxaban is eliminated via both metabolic degradation and renal elimination as unchanged drug. Therefore, renal and hepatic impairment may reduce rivaroxaban clearance, and medications inhibiting these clearance pathways could lead to drug\u2010drug interactions. This physiologically based pharmacokinetic (PBPK) study investigated the pharmacokinetic behavior of rivaroxaban in clinical situations where drug clearance is impaired. A PBPK model was developed using mass balance and bioavailability data from adults and qualified using clinically observed data. Renal and hepatic impairment were simulated by adjusting disease\u2010specific parameters, and concomitant drug use was simulated by varying enzyme activity in virtual populations (n = 1000) and compared with pharmacokinetic predictions in virtual healthy populations and clinical observations. Rivaroxaban doses of 10\u00a0mg or 20\u00a0mg were used. Mild to moderate renal impairment had a minor effect on area under the concentration\u2010time curve and maximum plasma concentration of rivaroxaban, whereas severe renal impairment caused a more pronounced increase in these parameters vs normal renal function. Area under the concentration\u2010time curve and maximum plasma concentration increased with severity of hepatic impairment. These effects were smaller in the simulations compared with clinical observations. AUC and C\n                    <jats:sub>max<\/jats:sub>\n                    increased with the strength of cytochrome P450 3A4 and P\u2010glycoprotein inhibitors in simulations and clinical observations. This PBPK model can be useful for estimating the effects of impaired drug clearance on rivaroxaban pharmacokinetics. Identifying other factors that affect the pharmacokinetics of rivaroxaban could facilitate the development of models that approximate real\u2010world pharmacokinetics more accurately.\n                  <\/jats:p>","DOI":"10.1002\/jcph.1784","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T04:28:44Z","timestamp":1605673724000},"page":"656-665","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Applications of Physiologically Based Pharmacokinetic Modeling of Rivaroxaban\u2014Renal and Hepatic Impairment and Drug\u2010Drug Interaction Potential"],"prefix":"10.1002","volume":"61","author":[{"given":"Stefan","family":"Willmann","sequence":"first","affiliation":[{"name":"Clinical Pharmacometrics Bayer AG  Wuppertal Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Coboeken","sequence":"additional","affiliation":[{"name":"Clinical Pharmacometrics Bayer AG  Wuppertal Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Kapsa","sequence":"additional","affiliation":[{"name":"Clinical Pharmacokinetics Cardiovascular Bayer AG  Wuppertal Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirstin","family":"Thelen","sequence":"additional","affiliation":[{"name":"Clinical Pharmacokinetics Cardiovascular Bayer AG  Wuppertal Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Mundhenke","sequence":"additional","affiliation":[{"name":"Medical Affairs Cardiovascular Bayer Vital GmbH  Leverkusen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Fischer","sequence":"additional","affiliation":[{"name":"Bayer Healthcare  K\u00f6ln Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"H\u00fcgl","sequence":"additional","affiliation":[{"name":"Clinic for Cardiology and Rhythmology Marienhaus Klinikum St Elisabeth Neuwied  Neuwied Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"M\u00fcck","sequence":"additional","affiliation":[{"name":"Clinical Pharmacokinetics Cardiovascular Bayer AG  Wuppertal Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Janssen Pharmaceuticals Inc. 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