OBJECT DRUGS

Anticoagulants, Oral:

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

PRECIPITANT DRUGS

Calcium Channel Blockers:

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

Comment:

Inhibitors of P-glycoprotein may increase the concentration of the anticoagulant. Since apixaban and rivaroxaban are also substrates for CYP3A4, 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

• Consider Alternative:Dihydropyridine calcium channel blockers such as felodipine (Plendil) or nifedipine (Procardia) do not appear to inhibit CYP3A4 or P-glycoprotein and would not be expected to alter anticoagulant concentrations.
• Monitor: Monitor for altered anticoagulant effect if one of these calcium channel blockers 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 conservative doses of anticoagulant.