August 18, 2016
View Full PaperDrug-drug interactions of non-vitamin K oral anticoagulants
Key Result
Drug-drug interactions with non-vitamin K oral anticoagulants primarily occur via P-glycoprotein transporter and cytochrome P450 enzyme complexes, which may necessitate dose modification.
Structured PICO
How do concomitant medications affect the absorption, metabolism, and coagulation of NOACs?
P
Population
Patients taking non-vitamin K oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban)
I
Intervention
Co-administration of other medications
O
Outcome
Drug-drug interactions affecting NOAC absorption, metabolism, and coagulationsafety
This review highlights that P-glycoprotein and CYP450 pathways are the primary mechanisms for NOAC drug-drug interactions, necessitating careful dose adjustments in clinical practice.
Limitations
- Most of the studies in this field have been organized by pharmaceutical companies.
Abstract
INTRODUCTION: The approval of non-vitamin K oral anticoagulants (NOACs) as antithrombotic alternatives to vitamin K antagonists (VKAs) has changed clinical practice. However, the efficacy and safety of the four most commonly used NOACs (dabigatran, rivaroxaban, apixaban and edoxaban) might be compromised by co-administration of other medications used for various major comorbidities. Dose adjustment of the NOACs may be needed to avert cases of concomitant medication affecting NOACs absorption, metabolism and coagulation. Areas covered: This review summarizes the current knowledge regarding drug-drug interactions of NOACs in order to guide health professionals regarding the dose modification required if the NOACs are co-administered with other medication with potential significant interactions. The data were acquired from searches of PubMed and also from the NOAC reports to the European Medicines Agency and Food and Drug Administration Agency. Expert opinion: Most of the studies in this field have been organized by pharmaceutical companies. Independent research and registries will provide more information in the near future about the drug-drug interactions of NOACs. P-glycoprotein transporter and cytochrome P450 enzyme complexes appear to be the main pathways where the most drug-drug interactions with NOACs occur.