Driftstatus

Nyheter i Janusmed

Janusmed

Driftstatus

Nyheter i Janusmed

Angående Äldre-knappen i Janusmed integrerad
Vi har för närvarande problem med visningen av Äldre-knappen i beslutsstödet Janusmed integrerad varför vi tillfälligtvis släckt tjänsten.
etoricoxib, omeprazol, Alvedon (Filmdragerad tablett), Movicol (Pulver till oral lösning i dospåse), Targiniq (Depottablett), Eliquis (Filmdragerad tablett), OxyNorm (Kapsel, hård)
  • etoricoxib
  • omeprazol
  • Alvedon (Filmdragerad tablett)
  • Movicol (Pulver till oral lösning i dospåse)
  • Targiniq (Depottablett)
  • Eliquis (Filmdragerad tablett)
  • OxyNorm (Kapsel, hård)
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10/2/2023

Janusmed interaktioner

Interaktioner

Startsida interaktioner

Aktuellt

Användarhandledning

E-utbildning

CYP3A4-hämmare/inducerare

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Administreringssätt

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1 interaktion mellan valda läkemedel
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Läkemedelsprodukt / substans
Interaktioner
Alvedon (Filmdragerad tablett)
paracetamol (Enteral peroral)

37

Eliquis (Filmdragerad tablett)
apixaban (Enteral peroral)

192

etoricoxib (Enteral och parenteral)

111

Movicol (Pulver till oral lösning i dospåse)
makrogol (Enteral peroral)

1

natrium (Enteral peroral)

0

natriumvätekarbonat (Enteral peroral)

8

omeprazol

122

OxyNorm (Kapsel, hård)
oxikodon (Enteral peroral)

63

Targiniq (Depottablett)
naloxon (Enteral peroral)

4

oxikodon (Enteral peroral)

63

C0 C0
C0 C0

apixaban - etoricoxib

apixaban - etoricoxib

Klass : C0

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apixaban

Enteral och parenteral

Eliquis (Filmdragerad tablett)

Eliquis (Filmdragerad tablett)
etoricoxib

Enteral och parenteral

Medicinsk konsekvens

Risken för blödning ökar, särskilt gastrointestinala blödningar.

Risken för blödning ökar, särskilt gastrointestinala blödningar.
Rekommendation

Kombinationen bör användas med försiktighet. För analgesi kan paracetamol vara ett bättre alternativ. Om samtidig behandling med acetylsalicylsyra/NSAID inte kan undvikas bör behandlingstiden för NSAID hållas så kort som möjligt och gastroprotektion med protonpumpshämmare kan övervägas.

Kombinationen bör användas med försiktighet. För analgesi kan paracetamol vara ett bättre alternativ. Om samtidig behandling med acetylsalicylsyra/NSAID inte kan undvikas bör behandlingstiden för NSAID hållas så kort som möjligt och gastroprotektion med protonpumpshämmare kan övervägas.
Mechanism

Additive inhibitory effects on the hemostasic system, thro......

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Additive inhibitory effects on the hemostasic system, through inhibition of coagulation and platelet aggregation. In addition, NSAIDs increase the risk of gastrointestinal bleedings through direct effects on the gastric mucosa.
Background

Co-treatment with apixaban and low-dose aspirin or clopido......

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Co-treatment with apixaban and low-dose aspirin or clopidogrel had no effect on bleeding time, thrombocyte aggregation or coagulation tests (prothrombin time, INR and aPTT), as compared to platelet inhibitor in monotherapy (1). However, a placebo-controlled trial in 1715 patients with acute coronary syndrome showed that addition of apixaban to a pre-existing therapy with low-dose aspirin or aspirin plus clopidogrel caused a more than two-fold increased risk of major (primarily gastrointestinal) bleedings (2). Addition of naproxen increased the Cmax and AUC of apixaban 1.5-fold and 1.6-fold, respectively. The increased exposure to apixaban was presumably due to P-glycoprotein inhibition by naproxen and was reflected in an increased factor X inhibition (1,3). In a nested case-control study from a Korean health care provider that included 28704 patients with atrial fibrillation, concomitant intake of direct oral anticoagulants (DOACs) with non-steroidal anti-inflammatory drugs (NSAIDs) caused a higher rate of major bleeding (defined as provoking hospitalization or emergency department visits) compared with patients who did not take NSAIDs (adjusted odds ratio 1.41 (95% confidence intervals (CI) 1.24-1.61)) (4). Intake of proton pump inhibitors was associated with less upper gastrointestinal bleeding (4). Of note, different DOACs and different NSAIDs were not analyzed separately. A subgroup analysis of the ARISTOTLE trial (5) showed similar results:Atrial fibrillation patients with incident NSAID treatment had a higher risk of major bleeding (hazard ratio 1.61 (95% CI 1.11-2.33)) and of clinically relevant non-major bleeding (hazard ratio 1.7 (95% CI 1.16-2.48)). Similar findings were reported for other DOACs (6, 7). A nationwide Danish study reported similar results: intake of NSAIDs concomitantly with apixaban resulted in a hazard ratio of 2.98 (95% CI 1.51-4.44) to experience gastrointestinal bleeding (8). Effect sizes for dabigatran and rivaroxaban were comparable (8).
Referenser

Visa referenser

  1. ELIQUIS (apixaban), Bistol-Meyers Squibb/Pfizer EEIG. SPC. 2011.

  2. , Alexander JH, Becker RC, Bhatt DL, Cools F, Crea F et al. Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) trial. Circulation. 2009;119:2877-85.

  3. Frost C, Shenker A, Gandhi MD, Pursley J, Barrett YC, Wang J et al. Evaluation of the effect of naproxen on the pharmacokinetics and pharmacodynamics of apixaban. Br J Clin Pharmacol. 2014.

  4. Lee MT, Park KY, Kim MS, et al. Concomitant Use of NSAIDs or SSRIs with NOACs Requires Monitoring for Bleeding. Yonsei Med J. 2020 Sep;61(9):741-9.

  5. Dalgaard F, Mulder H, Wojdyla DM, et al. Patients With Atrial Fibrillation Taking Nonsteroidal Anti-Inflammatory Drugs and Oral Anticoagulants in the ARISTOTLE Trial. Circulation. 2020 Jan 7;141(1):10-2.

  6. Kent AP, Brueckmann M, Fraessdorf M, et al. Concomitant Oral Anticoagulant and Nonsteroidal Anti-Inflammatory Drug Therapy in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2018 Jul 17;72(3):255-67.

  7. Kreutz R, Haas S, Holberg G, Lassen MR, Mantovani LG, Schmidt A et al. Rivaroxaban compared with standard thromboprophylaxis after major orthopaedic surgery: co-medication interactions. Br J Clin Pharmacol. 2016;81:724-34.

  8. Olsen AS, McGettigan P, Gerds TA, et al. Risk of gastrointestinal bleeding associated with oral anticoagulation and non-steroidal anti-inflammatory drugs in patients with atrial fibrillation: a nationwide study. Eur Heart J Cardiovasc Pharmacother. 2020 Sep 1;6(5):292-300.

  1. ELIQUIS (apixaban), Bistol-Meyers Squibb/Pfizer EEIG. SPC. 2011.
  2. , Alexander JH, Becker RC, Bhatt DL, Cools F, Crea F et al. Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) trial. Circulation. 2009;119:2877-85.
  3. Frost C, Shenker A, Gandhi MD, Pursley J, Barrett YC, Wang J et al. Evaluation of the effect of naproxen on the pharmacokinetics and pharmacodynamics of apixaban. Br J Clin Pharmacol. 2014.
  4. Lee MT, Park KY, Kim MS, et al. Concomitant Use of NSAIDs or SSRIs with NOACs Requires Monitoring for Bleeding. Yonsei Med J. 2020 Sep;61(9):741-9.
  5. Dalgaard F, Mulder H, Wojdyla DM, et al. Patients With Atrial Fibrillation Taking Nonsteroidal Anti-Inflammatory Drugs and Oral Anticoagulants in the ARISTOTLE Trial. Circulation. 2020 Jan 7;141(1):10-2.
  6. Kent AP, Brueckmann M, Fraessdorf M, et al. Concomitant Oral Anticoagulant and Nonsteroidal Anti-Inflammatory Drug Therapy in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2018 Jul 17;72(3):255-67.
  7. Kreutz R, Haas S, Holberg G, Lassen MR, Mantovani LG, Schmidt A et al. Rivaroxaban compared with standard thromboprophylaxis after major orthopaedic surgery: co-medication interactions. Br J Clin Pharmacol. 2016;81:724-34.
  8. Olsen AS, McGettigan P, Gerds TA, et al. Risk of gastrointestinal bleeding associated with oral anticoagulation and non-steroidal anti-inflammatory drugs in patients with atrial fibrillation: a nationwide study. Eur Heart J Cardiovasc Pharmacother. 2020 Sep 1;6(5):292-300.