2016


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2016/№5

Drug interactions of new oral anticoagulants: View of a clinical pharmacologist

Sychev D.A.1, Mirzaev K.B.1, Levanov A.N.2
1 – State Budgetary Educational Institution of Advanced Professional Education, “Russian Medical Academy of Postgraduate Education” of the RF Ministry of Health Care, Barrikadnaya 2/1, Moscow 123995
2 – State Budgetary Educational Institution, “V.I. Razumovsky Saratov State Medical University” of the RF Ministry of Health Care, Bolshaya Kazachjya 112, Saratov 410012

Keywords: new or al anticoagulants, drug inter actions, cytochrome P450 isoenzymes, P-glycoprotein, bleeding, atrial fibrillation, deep vein thrombosis

DOI: 10.18087/rhj.2016.5.2220

According to different reports, from 17 to 23% of prescribed combination medicinal products (MPs) are potentially dangerous, i.e., they may increase the risk of adverse side reactions (ASR). Thus, using 5 drugs or less is associated with ASR incidence of <5%, while during the use of >6 MPs, the ASR incidence sharply increases to 25%. In this process, anticoagulants, specifically vitamin Kantagonists and new oral anticoagulants (NOACs) lead in the incidence of clinically significant drug interactions. Specific pathways and interaction patterns are closely related with pharmacokinetic and pharmacodynamic features of NOACs, including rivaroxaban, dabigatran, apixaban, and edoxaban. Being substrates for P-glycoprotein transporter and CYP3A4 isoenzyme, NOACs are characterized with variability of pharmacokinetic parameters and clinical efficacy when used together with inhibitors or inductors of P-glycoprotein and CYP3A4. Therefore, prevention of ASRs related with drug interactions, primarily when using anticoagulants, is still an urgent issue for physicians.
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Sychev D.A., Mirzaev K.B., Levanov A.N. Drug interactions of new oral anticoagulants: View of a clinical pharmacologist. Russian Heart Journal. 2016;15 (5):335–341

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