doac
5 interactions related to doac
apixaban + fish oil
Apixaban is a direct factor Xa inhibitor that increases bleeding risk on its own. Omega-3 fatty acids in fish oil reduce platelet aggregation in a dose-dependent way; a 2024 JAHA systematic review of 120,643 patients found omega-3 doses of approximately 3 g/day or less of EPA+DHA did not significantly raise bleeding risk, while higher doses (notably high-purity EPA in cardiovascular trials) showed a small absolute increase in bleeding events.
rivaroxaban + fish oil
Omega-3 fatty acids in fish oil have mild antiplatelet and anticoagulant effects, reducing thromboxane A2 and prolonging bleeding time. Combined with rivaroxaban's Factor Xa inhibition, this can additively increase bleeding risk, particularly at fish oil doses above 3 g per day.
rivaroxaban + ginkgo
Ginkgo biloba has antiplatelet properties and may theoretically add to the bleeding risk of rivaroxaban, although a controlled pharmacokinetic study with EGb 761 found no change in rivaroxaban plasma levels or anti-Factor Xa activity. The risk is primarily additive rather than pharmacokinetic.
apixaban + st. john's wort
St. John's wort strongly induces both CYP3A4 (apixaban's primary metabolizing enzyme) and P-glycoprotein (its efflux transporter). Co-use accelerates apixaban metabolism and clearance, lowering plasma concentrations and increasing the risk of stroke or thromboembolism.
dabigatran + st. john's wort
St. John's wort is a potent inducer of P-glycoprotein (P-gp), the efflux transporter responsible for dabigatran disposition. Co-administration increases dabigatran efflux and reduces plasma concentrations, potentially leading to subtherapeutic anticoagulation and increased risk of stroke or thrombosis.