Apixaban; Dabigatran; Rivaroxaban/Fluconazole Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Medical warning:
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Some medicines may slow down how quickly your body processes your blood thinner.
What might happen:
The amount of your blood thinner in your blood may increase, which may increase your risk of bleeding, including bleeding from your gums, nosebleeds, unusual bruising, or dark stools.
What you should do about this interaction:
Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. If you have any signs of bleeding, such as bleeding from your gums, nosebleeds, unusual bruising, or dark stools, contact your doctor right away.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Chang SH, Chou IJ, Yeh YH, Chiou MJ, Wen MS, Kuo CT, See LC, Kuo CF. Association Between Use of Non-Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation. JAMA 2017 Oct 03;318(13):1250-1259.
- 2.FDA. Rivaroxaban CDER Application Number 202439Orig1s000 Clinical Pharmacology and Biopharmaceutics Review Addendum. avalable at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/202439orig1s000app rov.pdf January 5, 2011.
- 3.Holt A, Strange JE, Rasmussen PV, Blanche P, Nouhravesh N, Jensen MH, Schjerning AM, Schou M, Torp-Pedersen C, Gislason GH, Hansen ML, McGettigan P, Lamberts M. Bleeding Risk Following Systemic Fluconazole or Topical Azoles in Patients with Atrial Fibrillation on Apixaban, Rivaroxaban, or Dabigatran. Am J Med 2022 May;135(5):595-602.e5.
- 4.Cid A, Smetana ME, Hebert C, Coe K, Smith JM. Impact of concomitant fluconazole on direct oral anticoagulant bleeding risk. Pharmacotherapy 2022 Dec;42(12):880-889.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.