AI Article Synopsis
- Dabigatran, a thrombin inhibitor used to reduce stroke risk in non-valvular atrial fibrillation patients, shows altered blood concentration levels when combined with proton pump inhibitors (PPIs).
- PPI co-administration resulted in significantly lower average trough and peak dabigatran concentrations in patients, indicating a potential reduction in drug effectiveness.
- Clinicians should be cautious when prescribing PPIs alongside dabigatran due to the observed decrease in drug bioavailability, which may affect patient outcomes.
Article Abstract
Background: Dabigatran is a direct thrombin inhibitor used to decrease the risk of ischemic stroke in patients with non-valvular atrial fibrillation (NVAF). Its prodrug, dabigatran etexilate (DE) is often co-administrated with a proton pump inhibitor (PPI) because of its adverse effects on the gastrointestinal tract. Drug-drug interactions between DE and PPIs in daily clinical practice have not been fully elucidated.
Methods: Changes in blood dabigatran concentration (DC) were investigated using the dilute thrombin time test in a randomized, open-label, two-period crossover study including 34 Japanese patients with NVAF receiving dabigatran therapy with or without PPI.
Results: The average trough DC was significantly higher without PPI than with PPI (83 ± 42.3 55.5 ± 24.6 ng/mL, respectively; < 0.001). Similarly, the average peak DC was significantly higher without PPI than with PPI (184.1 ± 107.7 124 ± 59.2 ng/mL, respectively; = 0.0029). The average ratio of DC change at the trough and peak levels did not differ significantly among the three PPI types.
Conclusions: PPI administration significantly decreased the trough and peak DCs in patients with NVAF. Therefore, when prescribing PPIs for patients with NVAF in a clinical setting, the possibility that the bioavailability of dabigatran may decrease should be considered.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729000 | PMC |
| http://dx.doi.org/10.1016/j.joa.2017.07.013 | DOI Listing |
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