OBJECT DRUGS

• Dabigatran (Pradaxa)

PRECIPITANT DRUGS

Calcium Channel Blockers:

• Bepridil (Vascor)
• Diltiazem (Cardizem, etc.)
• Verapamil (Isoptin, etc.)

Comment:

These calcium channel blockers inhibit P-glycoprotein and may 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

• Consider Alternative: Dihydropyridine calcium channel blockers such as amlodipine (Norvasc), felodipine (Plendil), or nifedipine (Procardia) do not appear to inhibit P-glycoprotein and would not be expected to alter the absorption of dabigatran etexilate.
• Circumvent/Minimize: Administration of dabigatran at least 2 hours before the calcium channel blocker should minimize the effect on the absorption of dabigatran etexilate.
• Monitor: Monitor for altered dabigatran effect if one of these calcium channel blockers 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 conservative doses of dabigatran.