Table 5.
Drug-drug interactions of non-Vitamin K oral anticoagulants
| Class | Drugs | Dabigatran | Rivaroxaban | Apixaban | Edoxaban |
|---|---|---|---|---|---|
| Strong P-gp inhibitors (also CYP3A4 inhibitors) | Ciclosporin dronaderone itraconazole ketoconazole posaconazole tacrolimus voriconazole | Combination contraindicated | Strong recommendation not to use | Strong recommendation not to use | Reduce dose to 30 mg daily if on ciclosporin, dronaderone, erythromycin or ketoconazole |
| Other strong P-gp inhibitors (also CYP3A4 inhibitors) | Amiodarone clarithromycin quinidine verapami | Caution. If on verapamil give 110 mg twice daily | Avoid use particularly in renal impairment | Caution | Caution |
| Protease inhibitors (Pgp inhibitors and CYP3A4 inhibitors) | Ritonavir telaprevir | Concomitant use not recommended | Strong recommendation not to use | Strong recommendation not to use | No data |
| Strong P-gp and CYP3A4 inducers | Carbamazepine Phenobarbital Phenytoin Primidone Rifampicin St John’s Wor | Combination should be avoided | Combination should be avoided | Combination should be avoided | Use with caution |
| Other anticoagulants | E.g. LMWH, warfarin, UFH, fondaparinux | Combination contraindicated except when switching therapy or when UFH is given at doses necessary to maintain an open central venous or arterial catheter | Combination contraindicated except when switching therapy or when UFH is given at doses necessary to maintain an open central venous or arterial catheter | Combination contraindicated except when switching therapy or when UFH is given at doses necessary to maintain an open central venous or arterial catheter | Combination contraindicated except when switching therapy or when UFH is given at doses necessary to maintain an open central venous or arterial catheter |
| Others | Aspirin Clopidogrel NSAID’s | Combination not recommended. A careful risk-benefit assessment should be made | Combination not recommended. A careful risk-benefit assessment should be made | Combination not recommended. A careful risk-benefit assessment should be made | Combination not recommended. A careful risk-benefit assessment should be made |
| Prasugrel Ticagrelor | Combination not recommended | Combination not recommended | Combination not recommended | Combination not recommended |
LMWH=Low-molecular-weight heparins, UFH=Unfractionated heparin, NSAID=Nonsteroidal anti-inflammatory drug