Interactions between chemotherapeutic agents and immunosuppressants with NOACs based on known metabolic pathway activity
| . | Dabigatran . | Rivaroxaban . | Apixaban . |
|---|---|---|---|
| Interaction effect* . | P-glycoprotein . | P-glycoprotein CYP3A4 . | P-glycoprotein CYP3A4 . |
| Increases NOAC plasma levels† | Cyclosporine | Cyclosporine | Cyclosporine |
| Tacrolimus | Tacrolimus | Tacrolimus | |
| Tamoxifen | Tamoxifen | Tamoxifen | |
| Lapatinib | Lapatinib | Lapatinib | |
| Nilotinib | Nilotinib | Nilotinib | |
| Sunitinib | Sunitinib | Sunitinib | |
| Imatinib | Imatinib | ||
| Reduces NOAC plasma levels‡ | Dexamethasone | Dexamethasone | Dexamethasone |
| Doxorubicin | Doxorubicin | Doxorubicin | |
| Vinblastine | Vinblastine | Vinblastine |
| . | Dabigatran . | Rivaroxaban . | Apixaban . |
|---|---|---|---|
| Interaction effect* . | P-glycoprotein . | P-glycoprotein CYP3A4 . | P-glycoprotein CYP3A4 . |
| Increases NOAC plasma levels† | Cyclosporine | Cyclosporine | Cyclosporine |
| Tacrolimus | Tacrolimus | Tacrolimus | |
| Tamoxifen | Tamoxifen | Tamoxifen | |
| Lapatinib | Lapatinib | Lapatinib | |
| Nilotinib | Nilotinib | Nilotinib | |
| Sunitinib | Sunitinib | Sunitinib | |
| Imatinib | Imatinib | ||
| Reduces NOAC plasma levels‡ | Dexamethasone | Dexamethasone | Dexamethasone |
| Doxorubicin | Doxorubicin | Doxorubicin | |
| Vinblastine | Vinblastine | Vinblastine |
CYP3A4, cytochrome P450 3A4.
Clinicians should consult with the pharmacist to determine if these and other drug interactions exist when NOACs are being considered.
Drugs that inhibit P-glycoprotein transport or CYP3A4 pathway can increase NOAC levels.
Drugs that induce P-glycoprotein transport or CYP3A4 pathway can lower NOAC levels.