DOAC interactions

Question 1

Which drugs increase risk of bleeding

Answer 1

NSAIDs - caution or avoid
Alprostadil - caution or avoid
Antiplatelets e.g. aspirin, prasugrel - caution or avoid
SSRIs, SNRIs, vortioxetine, - caution or avoid
Heparin, other ACs, vit K antagonists
Thrombolytics e.g. alteplase, teneceplate, streptokinase

Question 2

Patient on a blood thinner wants to buy pepto bismol for heartburn. Is this allowed?

Answer 2

Bismuth subsalicylate is predicted to increase the risk of bleeding events. Manufacturer advises caution.

Question 3

The following increase the exposure to dabigatran/other doacs

Answer 3

Azithromycin, clarithromycin, azithromycin (macrolides)

Fluconazole, itraconazole, ketoconazole (avoid this one)

Mirabegron

Ranolozine

Ciclosporin, tacrolimus - avoid

Question 4

Avoid this class of drugs as they increase the exposure to dabigatran - hint they are in the immune & malignancy section, must be prescribed by brand

Answer 4

calcineurin inhibitors - ciclosporin, tacrolimus

can use with edoxaban but max dose is 30mg

for other DOACs, no recommendation

Question 5

This abx class increases exposure to dabigatran (no recommendation)

Answer 5

macrolides

Question 6

These drugs decrease exposure to dabigatran

Answer 6

avoid - st johns wort, rifampicin, phenytoin, fosphenytoin, carbamazepine

Question 7

Edoxaban has dose adjustments with the following drugs

Answer 7

Ciclosporin, erythromycin, ketoconazole, dronedarone

They increase exposure to edoxaban so Max 30mg edoxaban

Question 8

Pt is on ciclosporin. They need to be initiated on a DOAC. which one is most appropriate?

Answer 8

30mg edoxaban max dose

all other DOACs avoid