title: [Hemoptysis during concomitant treatment with rivaroxaban and amiodarone in a patient with a history of pulmonary disease].
abstract: Rivaroxaban, a selective inhibitor of active factor X, is metabolized by cytochrom P450 3A4 (CYP3A4) and is a substrate for transporter protein--P-glycoprotein (P-gp). Amiodarone, an antiarrhytmic agent, is classified as moderate CYP3A4 and P-gp inhibitor.
  
  
  METHODS
  A 75-year-old male, who underwent lobectomy for bronchiectasis many years ago, is presented. For one year the patient was treated with rivaroxaban (20 mg/d) due to venous thromboembolism and recurrent episodes of atrial fibrillation. Two weeks after amiodarone initiation (200 mg/d) hemoptysis occurred and computed tomography revealed unilateral pulmonary infiltrates with ground-glass opacities limited to the lower lobe of the left lung. The symptoms disappeared following discontinuation of the two medications and did not recur while rivaroxaban was reintroduced in a dose of 15 mg/d; measurement of anti-Xa activity confirmed it as a therapeutic dose. Amiodarone, that had been used for a short time and well tolerated a few years before, was definitely withdrawn.
  
  
  CONCLUSIONS
  The authors suggest, that the concomitant use of rivaroxaban and amiodarone should be very careful in patients with a history of pulmonary disease.
authors.affiliation: Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Elikowski
authors.affiliation: Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Małek
authors.affiliation: Wielkopolska Center of Pulmonology and Thoracic Surgery, Ludwikowo, n. Poznań, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Skowroński
authors.affiliation: Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Wróblewski
authors.affiliation: Radiology Unit, Józef Struś Hospital, Poznań, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Skrzywanek
authors.affiliation: Hemostasis Laboratory, Diagnostic and Therapeutic Center Interlab, Poznań
authors.forename: Krystyna
authors.initials: K
authors.lastname: Zawilska
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001987:Bronchiectasis / Q000150:complications* / Q000601:surgery; D004359:Drug Therapy, Combination; D065427:Factor Xa Inhibitors / Q000009:adverse effects; D006469:Hemoptysis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011859:Radiography; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy*
chemical_list: D000889:Anti-Arrhythmia Agents; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban; D000638:Amiodarone
keywords: amiodarone; hemoptysis; history of pulmonary disease; rivaroxaban