Effect of Gene Polymorphism in Drug-metabolizing Enzyme on Concentration of Rivaroxaban: A Narrative Review

Rivaroxaban is an anticoagulant agent that often experience biotransformation in the liver through CYP3A4/5 (18%); CYP2J2 (14%) and CYP independent hydrolytic cleavage (14%). Several studies revealed that Polymorphism in drug-metabolizing enzyme genes can affect the rivaroxaban levels in the body. Therefore, this study aims to review the effect of gene variations of metabolizing enzymes on rivaroxaban concentration in patient’s body. A search using keyword rivaroxaban, polymorphism, CYP3A4, CYP3A5 and CYP2J2 was carried out in Google Scholar. Several studies showed that polymorphisms of metabolizing genes do not have a significant effect on rivaroxaban concentration. There is also a need for comprehensive studies involving all single nucleotide polymorphisms (SNPs) that play a role in the drug’s pharmacokinetics. This is because rivaroxaban is metabolized by several CYP isoenzymes and excreted by different transporters. This still opens the opportunity for further studies on its pharmacogenomic.