title: Drug interactions between antiplatelet or novel oral anticoagulant medications and antiretroviral medications.
abstract: OBJECTIVE
  To review potential drug interactions between antiretroviral (ARV) medications and antiplatelets or novel oral anticoagulants (NOACs).
  
  
  METHODS
  A literature search of MEDLINE, PubMed, EMBASE, International Pharmaceutical Abstracts, and Google Scholar was performed using the search terms (1) clopidogrel or ticagrelor or prasugrel, (2) dabigatran or rivaroxaban or apixaban, and (3) antiretrovirals.
  
  
  METHODS
  Any English language study or case report describing a drug interaction between an ARV and an antiplatelet or NOAC was included. Additional information was taken from pharmacokinetic studies of individual agents alone or information from similar drug interactions.
  
  
  RESULTS
  Two studies were identified through the literature search: one reporting an in vivo interaction between ritonavir and prasugrel and the other an in vitro interaction between efavirenz and clopidogrel. A case report describing a drug interaction between nevirapine and rivaroxaban was also located. Information from pharmacokinetic studies and from similar drug interactions allowed for a comprehensive review of potential drug interactions.
  
  
  CONCLUSIONS
  There are potential drug interactions between ARVs, antiplatelet agents or NOACs. Management of these interactions may include selecting ARVs with a lower potential for drug interactions or choosing antiplatelet agents or NOACs least likely to interact with ARVs. With protease inhibitors or cobicistat, clopidogrel and dabigatran do not appear to have clinically significant interactions. Nonnucleoside reverse transcriptase inhibitors have a low potential for interactions with prasugrel and dabigatran. Clinically significant drug interactions are unlikely to occur between antiplatelet agents or NOACs and nucleoside reverse transcriptase inhibitors raltegravir, dolutegravir, or maraviroc.
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Gregory
authors.initials: G
authors.lastname: Egan
authors.forename: Christine A
authors.initials: CA
authors.lastname: Hughes
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Ackman
mesh_terms: D044966:Anti-Retroviral Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004347:Drug Interactions; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D044966:Anti-Retroviral Agents; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: antiplatelets; antiretrovirals; drug interaction; human immunodeficiency virus infection; novel oral anticoagulants