DOAC + CYP3A/P-gp inhibitor
- DOACs differ in CYP3A/P-gp dependence
- Strong dual inhibitors ↑ anticoagulant AUC
- apixaban + ketoconazole ≈ 2×
- rivaroxaban + ketoconazole ≈ 2.5×
- Bleeding risk rises
- Avoid/dose-adjust by the specific DOAC
Interaction at a glance
- Strong dual inhibitors ↑ anticoagulant AUC
- apixaban + ketoconazole ≈ 2×
- rivaroxaban + ketoconazole ≈ 2.5×
- Avoid/dose-adjust by the specific DOAC
Mechanism
- DOACs differ in CYP3A/P-gp dependence
Magnitude / time course
- Strong dual inhibitors ↑ anticoagulant AUC
- apixaban + ketoconazole ≈ 2×
- rivaroxaban + ketoconazole ≈ 2.5×
Clinical consequence
- Bleeding risk rises
Management
- Avoid/dose-adjust by the specific DOAC
Self-check
- Key risk with DOAC + CYP3A/P-gp inhibitor?
Bleeding risk rises. - How should DOAC + CYP3A/P-gp inhibitor be managed?
Avoid/dose-adjust by the specific DOAC.
Drugs in this interaction (12)
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