OBJECT DRUGS

• Dabigatran (Pradaxa)

PRECIPITANT DRUGS

P-glycoprotein Inhibitors:

• Amiodarone (Cordarone, etc.)
• Azithromycin (Zithromax, etc.)
• Clarithromycin (Biaxin, etc.)
• Conivaptan (Vaprisol)
• Cyclosporine (Neoral, etc.)
• Dronedarone (Multaq)
• Erythromycin (E-Mycin, etc.)
• Hydroxychloroquine
• Indinavir (Crixivan)
• Itraconazole (Sporanox, etc.)
• Ketoconazole (Nizoral, etc.)
• Nelfinavir (Viracept)
• Posaconazole (Noxafil)
• Propafenone (Rythmol, etc.)
• Quinidine (Quinidex)
• Ranolazine (Ranexa)
• Ritonavir (Norvir)
• Saquinavir (Invirase)
• Tacrolimus (Prograf, etc.)
• Tamoxifen (Nolvadex)
• Telaprevir (Incivek)
• Telithromycin (Ketek)

Comment:

Inhibitors of P-glycoprotein increase the absorption of the pro-drug dabigatran etexilate, but do not alter the kinetics of the active drug dabigatran. Dabigatran plasma concentrations may increase; monitor for increased anticoagulation effects.

Class 3: Assess Risk & Take Action if Necessary

• Circumvent/Minimize: Administration of dabigatran at least 2 hours before the P-glycoprotein inhibitor should minimize the effect on the absorption of dabigatran etexilate.
• Monitor: Monitor for altered dabigatran effect if one of these P-glycoprotein inhibitors is initiated, discontinued or changed in dosage; adjustments of dabigatran dosage may be needed. If dabigatran is initiated in the presence of therapy with one of these agents, consider initiating therapy with conservative doses of dabigatran.