Table 2.
Interactions of direct oral anticoagulants with potential COVID-19 therapies.a
| Co-administration is not recommended | ||
|---|---|---|
|
| ||
| DOAC | COVID-19 therapy | Commentary |
|
| ||
| Apixaban | Atazanavir | Atazanavir (potent CYP 3A4 and P-gp inhibitor): Potential increase of apixaban concentration |
|
|
|
|
| Dabigatran | Atazanavir (potent P-gp inhibitor): An increase of dabigatran concentration is expected | |
|
|
|
|
| Rivaroxaban | Atazanavir (potent CYP 3A4 and P-gp inhibitor): Potential increase of rivaroxaban concentration | |
|
| ||
| Apixaban | Lopinavir/ritonavir | Lopinavir/ritonavir (potent CYP 3A4 and P-gp inhibitor): Potential increase of apixaban concentration |
|
|
|
|
| Rivaroxaban | Lopinavir/ritonavir (potent CYP 3A4 and P-gp inhibitor): Potential increase of rivaroxaban concentration | |
|
| ||
| Potential clinically significant interaction (may require additional monitoring, dose adjustment, modification of timing of administration) | ||
|
| ||
| Edoxaban | Atazanavir | Atazanavir (potent P-gp inhibitor): Consider edoxaban dose reduction |
|
| ||
| Dabigatran | Lopinavir/ritonavir | Lopinavir/ritonavir (potent P-gp inhibitor): Close monitoring, mainly if renal insufficiency |
|
|
|
|
| Edoxaban | Lopinavir/ritonavir (potent P-gp inhibitor): Consider edoxaban dose reduction | |
|
| ||
| Dabigatran | Chloroquine | Chloroquine (P-gp inhibitor): Consider dabigatran dose reduction |
|
|
|
|
| Edoxaban | Chloroquine (P-gp inhibitor): Consider edoxaban dose reduction | |
|
| ||
| Dabigatran | Hydroxychloroquine | Hydroxychloroquine (P-gp inhibitor): Consider dabigatran dose reduction |
|
|
|
|
| Edoxaban | Chloroquine (P-gp inhibitor): Consider edoxaban dose reduction | |
|
| ||
| Dabigatran | Ruxolitinib | Ruxolitinib (P-gp inhibitor): Caution with concomitant use with dabigatran |
|
|
|
|
| Edoxaban | Ruxolitinib (P-gp inhibitor): Caution with concomitant use with edoxaban | |
|
| ||
| Potential weak interaction (no additional action may be required) | ||
|
| ||
| Apixaban | Tocilizumab | Unlikely that apixaban dose should be modified |
|
|
|
|
| Rivaroxaban | Unlikely that rivaroxaban dose should be modified | |
|
| ||
| Apixaban | Chloroquine | Chloroquine (P-gp and CYP 2C8 inhibitor): Modest impact on apixaban concentration |
|
|
|
|
| Rivaroxaban | Chloroquine (P-gp inhibitor): Modest impact on rivaroxaban concentration | |
|
| ||
| Apixaban | Hydroxychloroquine | Chloroquine (P-gp and CYP 2C8 inhibitor): Modest impact on apixaban concentration |
|
|
|
|
| Rivaroxaban | Chloroquine (P-gp inhibitor): Modest impact on rivaroxaban concentration | |
|
| ||
| Apixaban | Anakinra | Unlikely that apixaban dose should be modified |
|
|
|
|
| Rivaroxaban | Unlikely that rivaroxaban dose should be modified | |
|
| ||
| Apixaban | Sarilumab | Unlikely that apixaban dose should be modified |
|
|
|
|
| Rivaroxaban | Unlikely that rivaroxaban dose should be modified | |
|
| ||
| Apixaban | Azithromycin | Azithromycin (P-gp inhibitor): Modest impact on apixaban concentration |
|
|
|
|
| Dabigatran | Azithromycin (P-gp inhibitor): Modest impact on dabigatran concentration | |
|
|
|
|
| Edoxaban | Azithromycin (P-gp inhibitor): Modest impact on edoxaban concentration | |
|
|
|
|
| Rivaroxaban | Azithromycin (P-gp inhibitor): Modest impact on rivaroxaban concentration | |
|
| ||
| Unlikely clinically significant interaction | ||
|
| ||
| Apixaban | Baricitinib | |
| Dabigatran | Favipiravir | |
| Edoxaban | Interferon beta | |
| Rivaroxaban | Nitazoxanide | |
| Remdesivir | ||
| Ribavirin | ||
| Sofosbuvir | ||
|
| ||
| Dabigatran | Tocilizumab | |
|
| ||
| Edoxaban | ||
|
| ||
| Dabigatran | Anakinra | |
|
| ||
| Edoxaban | ||
|
| ||
| Dabigatran | Sarilumab | |
|
| ||
| Edoxaban | ||
|
| ||
| Apixaban | Ruxolitinib | |
|
| ||
| Rivaroxaban | ||
a
Data retrieved from Liverpool Drug Interactions Group.45
DOACs, direct oral anticoagulants; P-gp, P-glycoprotein.