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.