Ticagrelor pre-treatment significantly increased the Cmax (691.18 vs. 221.34 ng/mL) and AUC of rivaroxaban in rats (p < 0.05), indicating a pharmacokinetic drug-drug interaction.
Does ticagrelor pre-treatment alter the pharmacokinetics of rivaroxaban in rats?
Ticagrelor significantly increases the systemic exposure of rivaroxaban in rats, indicating a potential drug-drug interaction that warrants clinical investigation.
Absolute Event Rate: 691.18% vs 221.34%
p-value: p=< 0.05
Context Rivaroxaban and ticagrelor are two common drugs for the treatment of atrial fibrillation and acute coronary syndrome. However, the drug–drug interaction between them is still unknown.Objective To investigate the effects of ticagrelor on the pharmacokinetics of rivaroxaban in rats both in vivo and in vitro.Materials and methods A sensitive and reliable UPLC-MS/MS method was developed for the determination of rivaroxaban in rat plasma. Ten Sprague-Dawley rats were randomly divided into ticagrelor pre-treated group (10 mg/kg/day for 14 days) and control group. The pharmacokinetics of orally administered rivaroxaban (10 mg/kg, single dose) with or without ticagrelor pre-treatment was investigated with developed UPLC-MS/MS method. Additionally, Sprague-Dawley rat liver microsomes were also used to investigate the drug–drug interaction between these two drugs in vitro.Results The Cmax (221.34 ± 53.33 vs. 691.18 ± 238.31 ng/mL) and the AUC(0–t) (1060.97 ± 291.21 vs. 3483.03 ± 753.83 μg·h/L) of rivaroxaban increased significantly (p < 0.05) with ticagrelor pre-treatment. The MRT(0–∞) of rivaroxaban increased from 4.41 ± 0.79 to 5.97 ± 1.11 h, while the intrinsic clearance decreased from 9.93 ± 2.55 to 2.89 ± 0.63 L/h/kg (both p < 0.05) after pre-treated with ticagrelor. Enzyme kinetic study indicated that ticagrelor decreased rivaroxaban metabolic clearance with the IC50 value of 14.04 μmol/L.Conclusions Our in vivo and in vitro results demonstrated that there is a drug–drug interaction between ticagrelor and rivaroxaban in rats. Further studies need to be carried out to verify whether similar interactions truly apply in humans and whether these interactions have clinical significance.
Chong et al. (2020) studied Pharmacokinetics (n=10). Ticagrelor pre-treatment vs. Control group (without ticagrelor) was evaluated on Cmax of rivaroxaban (ng/mL) (p=< 0.05). Ticagrelor pre-treatment significantly increased the Cmax (691.18 vs. 221.34 ng/mL) and AUC of rivaroxaban in rats (p < 0.05), indicating a pharmacokinetic drug-drug interaction.