Key result
Coadministration of rivaroxaban and the protease inhibitor darunavir/ritonavir in an HIV-infected patient led to elevated rivaroxaban plasma levels and severe gastrointestinal bleeding.
Why the study?
Does the co-administration of rivaroxaban and protease inhibitors increase the risk of gastrointestinal bleeding in HIV-infected patients?
Case Report (n=1)
No
Does the co-administration of rivaroxaban and protease inhibitors increase the risk of gastrointestinal bleeding in HIV-infected patients?
Co-administration of rivaroxaban with protease inhibitors like ritonavir can lead to significantly increased anticoagulant exposure and severe bleeding complications, highlighting the need to avoid this combination.
May signal elevated bleeding risk with rivaroxaban plus HIV protease inhibitors; hypothesis-generating and should not yet change practice.
The use of rivaroxaban in fixed dosing regimens without need for routine coagulation monitoring may lead to the misconception that there is a minimal risk of drug-drug interactions. We describe the case of a patient infected with human immunodeficiency virus (HIV) on salvage therapy who developed gastrointestinal bleeding while receiving the standard dose of rivaroxaban for the prevention of venous thromboembolism after surgery. This case clearly sends a warning that protease inhibitors should not be co-administered with rivaroxaban. Furthermore, it highlights the importance of clinicians' caution about potential drug-drug interactions.
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Lakatos et al. (2014) conducted a case report in HIV infection and venous thromboembolism prophylaxis (n=1). Rivaroxaban and darunavir/ritonavir coadministration was evaluated on Gastrointestinal bleeding and rivaroxaban plasma concentration. Coadministration of rivaroxaban and the protease inhibitor darunavir/ritonavir in an HIV-infected patient led to elevated rivaroxaban plasma levels and severe gastrointestinal bleeding.
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