Table 3.
Potential drug-drug interaction (DDI) signals.
| Precipitant drug used concomitantly with an oral anticoagulant | Ratio of RRs (95% Confidence interval) | Possible mechanism of DDIs on the risk of thromboembolism46–49 |
|---|---|---|
| Warfarin | ||
| levonorgestrel | 5.04 (1.98, 12.83) | Unknown |
| norgestimate | 4.27 (1.64, 11.16) | Induction of CYP3A4 |
| diflunisal | 3.85 (1.34, 11.03) | Effect on hemostasis |
| sulindac | 3.70 (1.79, 7.62) | Effect on hemostasis |
| ethinyl_estradiol | 3.41 (1.71, 6.79) | Estrogen affects hemostasis |
| estropipate | 2.94 (1.24, 6.97) | Estrogen affects hemostasis |
| estradiol | 2.79 (1.83, 4.26) | Estrogen affects hemostasis |
| multivitamin_with_iron | 2.68 (1.35, 5.33) | Vitamin K, or possibly folic acid |
| etodolac | 2.61 (1.60, 4.25) | Effect on hemostasis |
| potassium_bicarbonate* | 2.44 (1.05, 5.65) | Bicarbonate may interfere with blood coagulation |
| rifampin | 2.25 (1.10, 4.61) | Induction of CYP1A2, 2A6, 2B6, 2C19, 2C8, 2E1, 3A4, 3A5, 3A7 |
| aspirin | 2.13 (1.72, 2.64) | Induction of CYP2C19 |
| dipyridamole | 2.07 (1.65, 2.60) | Unknown |
| carisoprodol* | 2.06 (1.43, 2.97) | Unknown |
| ibuprofen | 1.94 (1.50, 2.50) | Effect on hemostasis |
| raloxifene | 1.88 (1.18, 3.00) | Protein binding interaction |
| naproxen | 1.72 (1.35, 2.19) | Effect on hemostasis |
| eszopiclone* | 1.72 (1.12, 2.65) | Unknown |
| clopidogrel | 1.69 (1.56, 1.84) | Unknown |
| rabeprazole | 1.69 (1.24, 2.31) | Induction of CYP1A2 |
| hydromorphone* | 1.63 (1.08, 2.47) | Unknown |
| indomethacin | 1.62 (1.03, 2.55) | Effect on hemostasis |
| quinapril* | 1.53 (1.09, 2.13) | Unknown |
| enalapril* | 1.43 (1.16, 1.76) | Unknown |
| diclofenac | 1.43 (1.07, 1.92) | Effect on hemostasis |
| propoxyphene | 1.38 (1.08, 1.77) | Unknown |
| hydrocodone* | 1.33 (1.22, 1.46) | Unknown |
| acetaminophen | 1.28 (1.18, 1.38) | Unknown |
| celecoxib | 1.24 (1.02, 1.53) | Effect on hemostasis |
| meloxicam | 1.23 (1.02, 1.47) | Effect on hemostasis |
| hydrochlorothiazide* | 1.11 (1.03, 1.20) | Hemoconcentration of clotting factors |
| Dabigatran | ||
| pioglitazone* | 2.69 (1.44, 5.05) | Unknown |
| olmesartan* | 2.41 (1.43, 4.04) | Unknown |
| fenofibrate | 2.15 (1.22, 3.78) | Unknown |
| topiramate* | 2.04 (1.02, 4.05) | Induction of CYP3A4, substrate of P-glycoprotein |
| baclofen* | 1.81 (1.00, 3.26) | Unknown |
| citalopram | 1.69 (1.11, 2.57) | Unknown |
| spironolactone* | 1.59 (1.12, 2.27) | Induction of P-glycoprotein, hemoconcentration of clotting factors |
| digoxin* | 1.38 (1.04, 1.82) | Substrate of P-glycoprotein |
| hydrochlorothiazide* | 1.29 (1.02, 1.62) | Hemoconcentration of clotting factors |
| Rivaroxaban | ||
| ethinyl_estradiol | 4.15 (1.75, 9.81) | Estrogen affects hemostasis |
| dipyridamole | 3.49 (1.08, 6.64) | Effect on hemostasis |
| hyoscyamine* | 2.68 (1.31, 5.46) | Unknown |
| irbesartan* | 2.68 (1.39, 4.88) | Unknown |
| atropine* | 2.60 (1.03, 5.92) | Unknown |
| etodolac | 2.47 (1.18, 4.22) | Effect on hemostasis |
| phenytoin | 2.39 (1.33, 3.29) | Induction of CYP1A2, 2B6, 2C8, 2C19, 2C9, 3A4, 3A5, 3A7 |
| diphenoxylate* | 2.23 (1.44, 2.89) | Unknown |
| ranitidine* | 2.22 (1.27, 2.92) | Unknown |
| aspirin | 2.19 (1.21, 2.95) | Induction of CYP2C19 and P-glycoprotein |
| buspirone* | 2.09 (1.13, 2.66) | Unknown |
| fenofibrate | 2.04 (1.11, 2.55) | Unknown |
| sitagliptin* | 1.92 (1.32, 1.76) | Substrate of CYP3A4 and P-glycoprotein |
| naproxen | 1.89 (1.12, 1.43) | Effect on hemostasis |
| amitriptyline* | 1.73 (1.73, 7.03) | Unknown |
| ibuprofen | 1.68 (1.29, 4.44) | Effect on hemostasis |
| hydrocodone* | 1.52 (1.51, 3.28) | Unknown |
| acetaminophen* | 1.26 (1.46, 3.30) | Unknown |
| Apixaban | ||
| colesevelam* | 6.35 (2.61, 15.40) | Unknown |
| ibuprofen | 5.16 (3.00, 8.85) | Effect on hemostasis |
| amphetamine* | 3.76 (1.31, 10.80) | Unknown |
| dextroamphetamine* | 3.65 (1.34, 9.96) | Unknown |
| ramipril* | 2.84 (1.40, 5.76) | Unknown |
| chlorthalidone* | 2.60 (1.39, 4.84) | Unknown |
| penicillin_v_potassium* | 2.53 (1.02, 6.30) | Unknown |
| clopidogrel | 1.96 (1.53, 2.51) | Unknown |
| celecoxib | 1.80 (1.06, 3.06) | Effect on hemostasis |
| digoxin* | 1.39 (1.02, 1.88) | Substrate of P-glycoprotein |
| hydrocodone* | 1.36 (1.08, 1.71) | Unknown |
DDI – Drug-drug interaction, CYP – Cytochrome P450
*
Drug-drug interactions not documented in Lexicomp and/or Micromedex.