Venous Thromboembolism Due to Suspected Interaction Between Nevirapine and Rivaroxaban

Bates, Duane; Dalton, Bruce; Gilmour, Janet; Kapler, Jeff

doi:10.4212/cjhp.v66i2.1235

Cited by 14 publications

(22 citation statements)

References 18 publications

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“…Renal impairment ( n = 7) was the most relevant pathophysiological factor contributing to the development of ADRs. Concerning the mechanism of interaction, PK DDIs were involved in seventeen cases [ 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 ], PD DDIs in eight cases [ 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ] and PK/PD DDIs in three cases [ 88 , 89 , 90 ]. Bleeding ( n = 18) and thromboembolic events ( n = 7) were the two main ADRs described in these case reports.…”

Section: Resultsmentioning

confidence: 99%

“…In one case, rivaroxaban induced hepatic encephalopathy that led to death [ 90 ]. In the cases describing thromboembolic events or lack of efficacy measured with laboratory tests (coagulation parameters or anti-Factor Xa), the involved comedications were CYP3A and/or P-gp inducers, namely, rifampicin [ 68 , 73 ], nevirapine [ 72 ] and antiepileptic drugs, such as carbamazepine [ 64 , 66 , 77 ], oxcarbamazepine [ 65 ] or phenytoin [ 78 ]. PK DDIs with CYP3A and/or P-gp inhibitors led to bleeding events in all cases.…”

Section: Resultsmentioning

confidence: 99%

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Drug-Drug Interactions Leading to Adverse Drug Reactions with Rivaroxaban: A Systematic Review of the Literature and Analysis of VigiBase

Fernandez-Martinez

Lenoir

Samer

et al. 2021

JPM

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Rivaroxaban has become an alternative to vitamin K antagonists, which are considered to be at higher risk of drug-drug interactions (DDI) and more difficult to use. However, DDI do occur. We systematically reviewed studies that evaluated them and analysed DDI and subsequent adverse drug reactions (ADR) reported in spontaneous reports and VigiBase. We systematically searched articles that explored DDI with rivaroxaban up to 20 August 2018 via Medline, Embase and Google Scholar. Data from VigiBase came from spontaneous reports recovered up to 2 January 2018, where Omega was used to detect signals and identify potential interactions in terms of triplets with two drugs and one ADR. We identified 31 studies and 28 case reports. Studies showed significant variation in the pharmacokinetic for rivaroxaban, and an increased risk of haemorrhage or thromboembolic events due to DDI was highlighted in case reports. From VigiBase, a total of 21,261 triplets were analysed and the most reported was rivaroxaban–aspirin–gastrointestinal haemorrhage. In VigiBase, only 34.8% of the DDI reported were described or understood, and most were pharmacodynamic DDI. These data suggest that rivaroxaban should be considered to have significant potential for DDI, especially with CYP3A/P-gp modulators or with drugs that impair haemostasis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Drug-Drug Interactions Leading to Adverse Drug Reactions with Rivaroxaban: A Systematic Review of the Literature and Analysis of VigiBase

Fernandez-Martinez

Lenoir

Samer

et al. 2021

JPM

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“…Etravirine, efavirenz, and nevirapine are expected to reduce DOAC concentrations due to moderate CYP3A4 induction. 10,12 This becomes especially problematic when patients are receiving a CYP3A4 inhibitor and inducer concomitantly, such as Patients 3 and 4 in this case series. There are no known clinical data evaluating appropriate dosing of DOACs in this scenario, and in general when used alone, CYP3A4 inducers are not recommended.…”

Section: Discussionmentioning

confidence: 99%

Ritonavir- or cobicistat-boosted antiretroviral therapy and direct oral anticoagulants: A case for apixaban

Nisly

Stevens

2019

Int J STD AIDS

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Summary The potential for drug–drug interactions (DDIs) between direct oral anticoagulants and antiretroviral therapy (ART) is vast. Ritonavir and cobicistat are used as pharmacokinetic enhancers with either concurrent protease inhibitors or the integrase strand transfer inhibitor, elvitegravir, to optimize therapeutic concentrations by cytochrome P450 (CYP) inhibition. To date, only rivaroxaban and dabigatran have reported cases of use with ritonavir-boosted ART. Apixaban is metabolized similarly to rivaroxaban, but offers a dose reduction in the case of major DDIs. We report the successful use of reduced-dose apixaban to treat and prevent thromboembolic complications in six persons living with human immunodeficiency virus (HIV) on ritonavir- or cobicistat-boosted ART. This case series and available literature support the use of apixaban or dabigatran, depending on the boosted ART regimen.

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“…By the same mechanism, NOACs also have interaction with ART drugs . A case of decreased rivaroxaban concentration by concomitant nevirapine administration has been described, as the result of putative CYP3A induction and accelerated drug clearance .…”

Section: Managing Drug–drug Interactions In Patients With Hiv‐1 and Amentioning

confidence: 99%

Atrial fibrillation and human immunodeficiency virus type‐1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy

Pastori

Mezzaroma

Pignatelli

et al. 2019

Brit J Clinical Pharma

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The prevalence and incidence of atrial fibrillation/flutter (AF/AFL) in patients with human immunodeficiency virus type-1 (HIV-1) infection have been poorly investigated. We performed a systematic review using PubMed and Cochrane Database of Systematic Reviews, and screening of references, searching for clinical studies reporting on the association between HIV-1 infection and AF/AFL. We also summarized the main interactions of antiretroviral agents with antithrombotic and antiarrhythmic drugs. We found a prevalence of AF/AFL ranging from 2.0% to 5.13% in patients with HIV-1, with an incidence rate of 3.6/1000 personyears. Low CD4+ count (<200-250 cells ml À1 ) and high viral load were predictors of AF/AFL. Regarding drugs interactions, nucleoside reverse transcriptase inhibitors, integrase inhibitor and maraviroc have the lowest interactions with oral anticoagulants. Among anticoagulants, dabigatran presents the most favourable profile. Most of antiarrhythmic drugs interact with protease inhibitors, with beta blockers and diltiazem having fewer interactions. The few studies available suggest a non-negligible prevalence of AF/AFL in patients with HIV-1 infection. Awareness of potential interactions with anticoagulation and antiarrhythmic drugs is needed to offer optimal management in this population. CVD, even in treated HIV-1 patients [3]. Moreover, low CD4+ T cell count and/or failure to restore normal CD4+ T cell British Journal of Clinical PharmacologyBr J Clin Pharmacol (2019) 85 508-515 508

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Venous Thromboembolism Due to Suspected Interaction Between Nevirapine and Rivaroxaban

Cited by 14 publications

References 18 publications

Drug-Drug Interactions Leading to Adverse Drug Reactions with Rivaroxaban: A Systematic Review of the Literature and Analysis of VigiBase

Drug-Drug Interactions Leading to Adverse Drug Reactions with Rivaroxaban: A Systematic Review of the Literature and Analysis of VigiBase

Ritonavir- or cobicistat-boosted antiretroviral therapy and direct oral anticoagulants: A case for apixaban

Atrial fibrillation and human immunodeficiency virus type‐1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy

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