Drug-Drug Interaction between Daprodustat and Clopidogrel in Patients with Chronic Kidney Disease: A Case Series Study

This case series study investigated sudden increase in hemoglobin levels caused by daprodustat owing to drug-drug interaction in chronic kidney disease patients. Patients who started combination therapy with daprodustat and clopidogrel at Kainan Hospital between January 2021 and September 2023 were enrolled. Four patients were eligible during the study period; however, one patient met the exclusion criteria. Therefore, three patients were included in the study. Of the three eligible patients, two had received prior daprodustat and the other had received prior clopidogrel. In two out of the three patients, the rate of hemoglobin level increase exceeded 0.5 g/dL per week immediately after the initiation of the combination. Patients with confirmed elevated hemoglobin levels were initiated on a daily dose of 4 mg of daprodustat, while those without confirmed hemoglobin elevation were started on a daily dose of 2 mg of daprodustat. No daprodustat-related adverse events were identified in any of the patients. In conclusion, drug-drug interactions between daprodustat and clopidogrel may lead to unexpected overshoot. A lower starting dose of daprodustat should be considered when combined with clopidogrel. Hemoglobin levels should be monitored for potential elevation when starting clopidogrel under daprodustat administration. More detailed studies are needed in the future, as more cases are accumulated.