OBJECT DRUGS

Anticoagulants, Oral:

• Apixaban (Eliquis)
• Betrixaban (Bevyxxa)
• Dabigatran (Pradaxa)
• Edoxaban (Savaysa)
• Rivaroxaban (Xarelto)

PRECIPITANT DRUGS

P-glycoprotein Inducers:

• Carbamazepine (Tegretol, etc.)
• Dexamethasone (Decadron, etc.)
• Phenytoin (Dilantin, etc.)
• Rifampin (Rimactane, etc.)
• St. John's Wort
• Tipranavir (Aptivus)

Comment:

Rifampin has been reported to markedly reduce the plasma concentration of dabigatran. Other P-glycoprotein inducers are likely to have a similar effect on these anticoagulants. Several days to weeks may be required to see the full effect a P-glycoprotein inducer on the anticoagulant. Since apixaban and rivaroxaban are also substrates for CYP3A4, precipitant drugs that induce both CYP3A4 and P-glycoprotein may produce a larger decrease in anticoagulant concentrations.

Class 3: Assess Risk & Take Action if Necessary

• Monitor: Monitor for altered anticoagulant effect if a P-glycoprotein inducer is initiated, discontinued or changed in dosage; adjustments of anticoagulant dosage may be needed.