Thrombosis

Thrombosis / 2013 / Article / Tab 2

Review Article

New Oral Anticoagulants in the Treatment of Pulmonary Embolism: Efficacy, Bleeding Risk, and Monitoring

Table 2

Selected P-glycoprotein and Cytochrome P450 3A4 drug interactions with NOAC based on current FDA-approved indications [18, 21, 31, 32].

Medications+Mechanism of InteractionDabigatran#  
(Pradaxa)
Rivaroxaban   
(Xarelto)
Apixaban  
(Eliquis)

RifampinP-glycoprotein inducerAvoid combinationAvoid Avoid

Carbamazepine, phenytoin,
St. John’s wort
P-glycoprotein inducers and
Strong 3A4 inducers
Avoid AvoidAvoid

DronedaroneP-glycoprotein inhibitorsFor CrCl 30–50 mL/min:  
Dose reduction suggested in dosing for Atrial Fibrillation
For CrCl < 30 mL/min:
Aviod
Not addressed in Package InsertNot addressed

Systemic ketoconazole ItraconazoleP-glycoprotein inhibitors and
Strong 3A4 inhibitors
For CrCl 30–50 mL/min:
Dose reduction suggested in dosing for Atrial Fibrillation
AvoidReduce dose in 1/2 for those starting on the full dose of 5 mg BID%

lopinavir/ritonavir, ritonavir,
indinavir/ritonavir, conivaptan
P-glycoprotein inhibitors and
Strong 3A4 inhibitor
Not addressed in Package InsertAvoidReduce dose in for those starting on the full dose of 5 mg BID%

Verapamil, amiodarone, quinidine,P-glycoprotein inhibitorsFor CrCl 30–50 mL/min:  
No dose adjustment needed, monitor clinical course
For CrCl < 30 mL/min:
Aviod
Not addressed in Package InsertReduce dose in for those starting on the full dose of 5 mg BID%

ClarithromycinP-glycoprotein inducers and strong 3A4 inducersFor CrCl < 30 mL/min  
Avoid
For CrCl 30–50 mL/min:
No dose adjustment needed, monitor clinical course
Unclear: refer to package insert.Reduce dose in for those starting on the full dose of 5 mg BID%

CrCl: creatinine clearance as determined by Crockcoft-Gault equation.
#Dabigatran etexilate (prodrug) uses the p-glycoprotein transport system. It is not a substrate, inducer, or inhibitor of the cytochrome p450 system.
Rivaroxaban is a substrate for cytochrome p450 as well as p-glycoprotein.
+Listed medications are representatives of potent 3A4 inhibitors and may not be comprehensive.
%Those patients who need to start at 2.5 mg BID should avoid this combination.

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