New oral anticoagulants (dabigatran, rivaroxaban, apixaban) have important drug interactions with P-glycoprotein and CYP3A4 inhibitors or inducers, NSAIDs, and antiplatelets requiring caution.
What are the drug, food, and dietary supplement interactions associated with the new oral anticoagulants dabigatran, rivaroxaban, and apixaban?
New oral anticoagulants have significant drug-drug and drug-food interactions, particularly with P-glycoprotein and CYP3A4 modulators, NSAIDs, and antiplatelets, requiring careful evaluation in clinical practice.
Oral warfarin is associated with extensive food and drug interactions, and there is a need to consider such interactions with the new oral anticoagulants (OACs) dabigatran etexilate, rivaroxaban and apixaban. A literature survey was conducted using PubMed, EMBASE and recent abstracts from thrombosis meetings to identify publications related to food, drug and dietary supplement interaction studies with dabigatran etexilate, rivaroxaban and apixaban. Clinical experience regarding food interactions is currently limited. Regarding drug-drug interactions, dabigatran requires caution when used in combination with strong inhibitors or inducers of P-glycoprotein, such as amiodarone or rifampicin. Rivaroxaban (and possibly apixaban) is contraindicated in combination with drugs that strongly inhibit both cytochrome P450 3A4 and P-glycoprotein, such as azole antimycotics, and caution is required when used in combination with strong inhibitors of only one of these pathways. Important drug interactions of the new OACs that can lead to adverse clinical reactions may also occur with non-steroidal anti-inflammatory drugs and antiplatelet drugs, such as aspirin and clopidogrel. Over-the-counter (OTC) medications and food supplements (e.g. St. John's Wort) may also interact with the new OACs. Given the common long-term use of drugs for some chronic disorders, the frequent use of OTC medications and the need for multiple treatments in special populations, such as the elderly people, it is essential that the issue of drug interactions is properly evaluated. New OACs offer significant potential advantages to the field of venous thromboprophylaxis, but we should not fail to appreciate their lack of extensive clinical experience.
Walenga et al. (Mon,) conducted a review in Patients requiring oral anticoagulation. New oral anticoagulants (dabigatran etexilate, rivaroxaban, apixaban) was evaluated. New oral anticoagulants (dabigatran, rivaroxaban, apixaban) have important drug interactions with P-glycoprotein and CYP3A4 inhibitors or inducers, NSAIDs, and antiplatelets requiring caution.