title: Drug-drug interactions of non-vitamin K oral anticoagulants.
abstract: The approval of non-vitamin K oral anticoagulants (NOACs) as antithrombotic alternatives to vitamin K antagonists (VKAs) has changed clinical practice. However, the efficacy and safety of the four most commonly used NOACs (dabigatran, rivaroxaban, apixaban and edoxaban) might be compromised by co-administration of other medications used for various major comorbidities. Dose adjustment of the NOACs may be needed to avert cases of concomitant medication affecting NOACs absorption, metabolism and coagulation. Areas covered: This review summarizes the current knowledge regarding drug-drug interactions of NOACs in order to guide health professionals regarding the dose modification required if the NOACs are co-administered with other medication with potential significant interactions. The data were acquired from searches of PubMed and also from the NOAC reports to the European Medicines Agency and Food and Drug Administration Agency. Expert opinion: Most of the studies in this field have been organized by pharmaceutical companies. Independent research and registries will provide more information in the near future about the drug-drug interactions of NOACs. P-glycoprotein transporter and cytochrome P450 enzyme complexes appear to be the main pathways where the most drug-drug interactions with NOACs occur.
authors.affiliation: a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , UK.
authors.forename: Christos
authors.initials: C
authors.lastname: Voukalis
authors.affiliation: a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , UK.
authors.forename: Eduard
authors.initials: E
authors.lastname: Shantsila
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism; D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D006801:Humans
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D003577:Cytochrome P-450 Enzyme System
keywords: Non-vitamin K oral anticoagulants; P-glycoprotein; apixaban; cytochrome P450(CYP); dabigatran; drug-drug interactions; edoxaban; rivaroxaban