Drug-drug interactions with the new oral anticoagulants

Abstract

Drug-drug interactions (DDI) and adverse drug effects (ADR) have received much attention because many patients are being hospitalized or remain hospitalized longer than necessary. The use of multiple drugs (8-12 on average in hospitalized patients) is common in a number of therapeutic regimens. Anticoagulant drugs are among the most commonly implicated medications that cause ADR in hospitalized patients and medication errors involving anticoagulant drugs remain common. Elderly and cardiac patients represent populations at particularly high risk for suffering anticoagulant-associated ARD and drug interactions. We review clinically significant pharmacokinetic and pharmacodynamic drug-drug interactions (DDIs) with the new oral anticoagulants, including dabigatran, rivaroxaban, and apixaban. The main pharmacokinetic drug interactions are focused on drugs affecting the permeability glycoprotein (P-gp) efflux transporter protein and/or cytochrome P- 450 enzymes. Awareness of drugs that are involved in drug-drug interactions and especially those that alter the function of the P-gp efflux transporter protein and CYP enzymes and provide adverse effects should enable clinicians to anticipate and avoid potential DDIs involving the anticoagulants.