Table 3. Summary of clinically relevant drug-drug interactions with the use of NOACs in clinical practice.

NOACs	Co-administered drugs	Comments/recommendations
Dabigatran	Strong inhibitors of P-gp	Dabigatran dose should be reduced to 75 mg bid if co-administration is planned in presence of moderate renal impairment (Crcl 30-50 mL/min)
	Less potent inhibitors of P-gp	No dose-adjustment is recommended
	P-gp inducers	Co-administration is not recommended
Rivaroxaban	Strong inhibitors of P-gp and CYP3A4	Co-administration not recommended, risk of increased bleeding risk
	Less potent inhibitors of P-gp and CYP3A4	No dose-adjustment is recommended
	Strong inducers of CYP3A4 and/or P-gp	Co-administration is recommended with caution, leads to decreased effect of rivaroxaban
Apixaban	Strong dual inhibitors of P-gp and/or CYP3A4	Recommended to reduce the dose to 2.5 mg bid If the patient is already taking apixaban 2.5 mg bid, avoid co-administration of the strong dual P-gp and CYP3A4 inhibitors
	Less potent inhibitors of CYP3A4 and/or P-gp	No dose-adjustment is recommended
	Strong inducers of P-gp and/or CYP3A4	Avoid the concomitant use of these agents to prevent decrease in the efficacy of apixaban

(I) Strong inhibitors of P-gp and/or CYP3A4 (e.g., ketoconazole, itraconazole, ritonavir, clarithromycin); (II) less potent inhibitors of CYP3A4 and/or P-gp (e.g., amiodarone, diltiazem, verapamil); (III) strong inducers of P-gp and/or CYP3A4 (e.g., rifampin, carbamazepine, phenytoin, St. John Wort). AF, atrial fibrillation; NOACs, novel oral anticoagulants; P-gp, permeability glycoprotein.