Key result
Co-administration of rivaroxaban and the strong CYP3A4-inducer rifampicin led to subtherapeutic rivaroxaban levels (178 ng/mL) and a fatal pulmonary embolism in a 67-year-old woman.
Case Report (n=1)
No
Concomitant use of rivaroxaban with strong CYP3A4 inducers like rifampicin can lead to dangerously subtherapeutic anticoagulant levels and fatal thromboembolic complications.
May warrant caution with rivaroxaban and strong CYP3A4 inducers; leaves open interaction risk magnitude.
The introduction of the novel oral anticoagulants (NOAC), such as the direct Factor Xa-inhibitors rivaroxaban and apixaban and the thrombin-inhibitor dabigatran, have provided an effective and safe alternative to vitamin K antagonists (VKA) for the prevention of thromboembolic complications in
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Altena et al. (2014) conducted a case report in Drug-drug interaction leading to pulmonary embolism (n=1). Rivaroxaban and rifampicin co-administration was evaluated on Clinical outcome and plasma rivaroxaban concentration. Co-administration of rivaroxaban and the strong CYP3A4-inducer rifampicin led to subtherapeutic rivaroxaban levels (178 ng/mL) and a fatal pulmonary embolism in a 67-year-old woman.
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