DOACs - main interactions

Last edited 06/2019 and last reviewed 04/2022

Direct Oral AntiCoagulants (DOAC - apixaban, dabigatran, edoxaban and rivaroxaban) drug interactions (1,2)

Dabigatran and edoxaban are substrates for P-glycoprotein (P-gp)

Apixaban and rivaroxaban are metabolised by cytochrome P450 enzyme CYP3A4 and are substrates for P-gp

There is study evidence that among patients taking DOACs for non-valvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampicin, and phenytoin compared with the use of DOACs alone, was associated with increased risk of major bleeding (3).

The table below outlines main DOAC drug interactions:

Reference:

• Barnes GD, Ageno W, Ansell J, Kaatz S. Recommendation on the nomenclature for oral anticoagulants: communications from the SSC of the ISTH: reply. J Thromb Haemost. 2015;13((11)):2132-3.
• Nottingham University Hospitals NHS Trust. Direct Oral AntiCoagulants (DOAC - apixaban, dabigatran, edoxaban and rivaroxaban) drug interactions (Accessed 2/1/19).
• Chang S et al.Association Between Use of Non-Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation. JAMA. 2017 Oct 3;318(13):1250-1259