Klin Farmakol Farm. 2025;39(1):22-33 | DOI: 10.36290/far.2025.014

Pharmacokinetic drug-drug interactions of direct oral anticoagulants

Josef Suchopár, Michal Prokeš, Štěpán Suchopár
DrugAgency, a. s., Praha

Direct-acting oral anticoagulants (DOACs) - dabigatran etexilate, rivaroxaban, apixa­ban and edoxaban - have a number of clinically significant pharmacokinetic drug interactions, with significant differences in the severity of these interactions between individual drugs. Metabolic and transport processes play a key role, especially metabolism via CYP3A4 and CYP2J2 and the transport via P-glycoprotein and possibly BCRP. Inhibitors and inducers of these enzymes and transport systems can change DOAC exposure and thus the risk of bleeding, or the risk of reduced efficacy or failure of therapy. Knowledge of these drug interactions is crucial for optimizing therapy and preventing complications. Underestimation or, conversely, overestimation of the impact of these drug interactions can negatively affect the safety and efficacy of therapy.

Keywords: dabigatran etexilate, dabigatran, apixaban, edoxaban, rivaroxaban, drug interactions.

Accepted: April 15, 2025; Published: April 29, 2025  Show citation

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Suchopár J, Prokeš M, Suchopár Š. Pharmacokinetic drug-drug interactions of direct oral anticoagulants. Klin Farmakol Farm. 2025;39(1):22-33. doi: 10.36290/far.2025.014.
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