OBJECT DRUGS
Anticoagulants, Oral:
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
PRECIPITANT DRUGS
Enzyme Inhibitors:
- Amiodarone (Cordarone, etc.)
- Amprenavir (Agenerase)
- Aprepitant (Emend)
- Atazanavir (Reyataz)
- Boceprevir (Victrelis)
- Ceritinib (Zykadia)
- Cobicistat (Stribild)
- Conivaptan (Vaprisol)
- Cyclosporine (Neoral, etc.)
- Danazol (Danocrine)
- Darunavir (Prezista)
- Imatinib (Gleevec)
- Delavirdine (Rescriptor)
- Dronedarone (Multaq)
- Indinavir (Crixivan)
- Lapatinib (Tykerb)
- Lomitapide (Juxtapid)
- Mifepristone (Korlym)
- Nefazodone
- Nelfinavir (Viracept)
- Ritonavir (Norvir)
- Saquinavir (Invirase)
- Tamoxifen (Nolvadex)
- Telaprevir (Incivek)
Comment:
These precipitant drugs inhibit CYP3A4 and may increase the plasma concentration of apixaban and rivaroxaban. Since apixaban and rivaroxaban are also substrates for P-glycoprotein, precipitant drugs that inhibit both CYP3A4 and P-glycoprotein may produce a larger increase in anticoagulant concentrations.
Class 3: Assess Risk & Take Action if Necessary
- Monitor: Monitor for altered anticoagulant effect if one of these inhibitors is initiated, discontinued or changed in dosage; adjustments of anticoagulant dosage may be needed. If the anticoagulant is initiated in the presence of therapy with one of these agents, consider initiating therapy with conservative doses of anticoagulant.