Table 13.
Permeability glycoprotein (p-gp) drug–drug interactions with dabigatran and edoxaban [16, 48, 59, 130–135] (list is not exhaustive)
| P-gp inducers | Interacting drug’s effect on dabigatran and edoxaban concentrations | Suggested management |
|---|---|---|
| Barbiturates | ↓, no specific studies | Avoid use of dabigatran or edoxaban with p-gp inducers |
| Carbamazepine | ↓, no specific studies | |
| Dexamethasone | ↓, no specific studies | |
| Phenytoin | ↓, no specific studies | |
| Rifampin | ↓ dabigatran exposure by 66 % ↓ edoxaban exposure |
|
| St John’s Wort | ↓, no specific studies |
| P-gp inhibitors | Interacting drug’s effect on dabigatran and edoxaban concentrations | Suggested management |
|---|---|---|
| Amiodarone | ↑, dabigatran exposure by 12-58 % ↑, edoxaban exposure by 40 % |
Avoid use of dabigatran with any p-gp inhibitor if the patient’s CrCl is < 50 mL/min Reduce edoxaban dose from 60 mg once daily to 30 mg once daily if patient is also taking a p-gp inhibitor |
| Carvedilol | ↑, no specific studies | |
| Clarithromycin | ↑, dabigatran exposure by 49 % ↑, no specific studies with edoxaban |
|
| Conivaptan | ↑, no specific studies | |
| Cyclosporine | ↑, dabigatran exposure in in vitro studies ↑, edoxaban exposure |
|
| Diltiazem | ↑, no specific studies | |
| Dronedarone | ↑, dabigatran exposure by 70–140 % ↑, edoxaban exposure by 85 % |
|
| Erythromycin | ↑, no specific studies with dabigatran ↑, edoxaban exposure |
|
| Grapefruit | ↑, no specific studies | |
| Indinavir | ↑, no specific studies | |
| Itraconazole | ↑, dabigatran exposure in in vitro studies ↑, no specific studies with edoxaban |
|
| Ketoconazole | ↑, dabigatran exposure by 153 % ↑, edoxaban exposure |
|
| Lapatinib | ↑, no specific studies | |
| Mefloquine | ↑, no specific studies | |
| Nelfinavir | ↑, dabigatran exposure in in vitro studies ↑, no specific studies with edoxaban |
|
| Nicardipine | ↑, no specific studies | |
| Propafenone | ↑, no specific studies | |
| Quinidine | ↑, dabigatran exposure by 53 % ↑, edoxaban exposure by 77 % |
|
| Ritonavir | ↑, dabigatran exposure in in vitro studies ↑, no specific studies with edoxaban |
|
| Saquinavir | ↑, no specific studies | |
| Tacrolimus | ↑, dabigatran exposure in in vitro studies ↑, no specific studies with edoxaban |
|
| Tamoxifen | ↑, no specific studies | |
| Verapamil | ↑, dabigatran exposure by 23–54 % ↑, edoxaban exposure by 53 % |
CrCl Creatinine clearance, p-gp permeability glycoprotein