Key result
Concurrent use of nevirapine may have increased the hepatic clearance of rivaroxaban through CYP3A4 induction, leading to subtherapeutic anticoagulation and early venous thromboembolism in a 60-year-old man after knee replacement.
Why the study?
Does the concurrent use of nevirapine and rivaroxaban increase the risk of venous thromboembolism due to drug interaction in patients undergoing total knee replacement?
Case Report (n=1)
No
Does the concurrent use of nevirapine and rivaroxaban increase the risk of venous thromboembolism due to drug interaction in patients undergoing total knee replacement?
Concurrent use of nevirapine, a CYP3A4 inducer, may increase the clearance of rivaroxaban, potentially leading to subtherapeutic anticoagulation and an increased risk of venous thromboembolism.
Alerts clinicians to possible nevirapine-rivaroxaban interaction after orthopedic surgery; leaves open need for pharmacokinetic confirmation.
Rivaroxaban is a selective, reversible inhibitor of factor Xa that is used for the prevention and treatment of venous thromboembolism (VTE) and for the prevention of stroke in patients with atrial fibrillation. Nevirapine is a non-nucleoside reverse transcriptase inhibitor that is generally given in com bination with 2 nucleoside reverse transcriptase inhibitors to suppress HIV in infected individuals. Both medications are metabolized in the liver through the cytochrome (CYP) P450 pathway. Nevirapine is also an enzyme inducer that may increase the clearance of rivaroxaban. There is a lack of information about drug interactions involving rivaroxaban after total joint replacement surgery. We report a case of VTE after total knee replacement that may have been due to an interaction between rivaroxaban and nevirapine.
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Bates et al. (2013) conducted a case report in Venous Thromboembolism (n=1). Concurrent use of rivaroxaban and nevirapine was evaluated. Concurrent use of nevirapine may have increased the hepatic clearance of rivaroxaban through CYP3A4 induction, leading to subtherapeutic anticoagulation and early venous thromboembolism in a 60-year-old man after knee replacement.
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