(DOAC interactions) Cancer-treatment specific inducers (↑) and inhibitors (↓)
of cytochrome p450 CYP3A4 and P-glycoprotein.
DOACs are substrates to CYP3A4 and P-glycoprotein enzymes. Inducers of these enzymes may potentially increase
metabolization of DOACs thereby leading to lower plasma concentrations, and inhibitors
may decrease metabolization leading to higher plasma concentrations. Edoxaban,
rivaroxaban, and apixaban are reported to have major interactions with the P-glycoprotein
pathway. Rivaroxaban and apixaban are reported to have major interactions with the
CYP3A4 pathway whereas edoxaban has been reported to have minor interactions.
Dabigatran has moderate interactions with the P-glycoprotein pathway. The extent to which
plasma concentrations of DOACs are influenced by inducers or inhibitors of CYP3A4 and
P-glycoprotein is unknown.
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