title: Drug Interactions of Direct-Acting Oral Anticoagulants.
abstract: In recent years, new direct-acting oral anticoagulants (DOACs) have been introduced into clinical practice that specifically inhibit either factor Ia or Xa. These drugs have, to a large extent, replaced warfarin for the treatment of venous thrombosis, pulmonary embolism, and non-valvular atrial fibrillation. They have potential advantages over warfarin in providing more stable anticoagulation and the lack of a need for regular venesection to monitor activity. They also have the promise of less drug and food interactions. All of these drugs are substrates for the permeability glycoprotein (P-gp) excretion system, and several are metabolised, in part, by cytochrome P450 (CYP) 3A4. This current article assesses the interactions that do or may occur with the DOACs, particularly with respect to the P-gp and CYP3A4 systems.
authors.affiliation: Cardiac Services, Gold Coast University Hospital, Southport, QLD, 4215, Australia.
authors.forename: John Leonard
authors.initials: JL
authors.lastname: Fitzgerald
authors.affiliation: Cardiac Services, Gold Coast University Hospital, Southport, QLD, 4215, Australia. laurie.howes@health.qld.gov.au.|School of Medicine, Faculty of Health Sciences, Griffith University, Gold Coast, Parkwood, QLD, 4215, Australia. laurie.howes@health.qld.gov.au.
authors.forename: Laurence Guy
authors.initials: LG
authors.lastname: Howes
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D004347:Drug Interactions; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D018565:Food-Drug Interactions; D006801:Humans; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D014859:Warfarin; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human