Drug Interaction Report

GENERALLY AVOID: Coadministration with inducers of P-glycoprotein (P-gp) may significantly reduce the bioavailability of dabigatran following oral administration of dabigatran etexilate, which is a substrate of the efflux transporter. When a single dose of dabigatran etexilate was administered following pretreatment with the P-gp inducer rifampin (600 mg once daily for 7 days), dabigatran peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by approximately two-thirds compared to the reference treatment. Dabigatran exposure was close to normal seven days after cessation of rifampin.

MANAGEMENT: Concomitant use of dabigatran with P-gp inducers should generally be avoided.

GENERALLY AVOID: Concurrent acute use of barbiturates and ethanol may result in additive CNS effects, including impaired coordination, sedation, and death. Tolerance of these agents may occur with chronic use. The mechanism is related to inhibition of microsomal enzymes acutely and induction of hepatic microsomal enzymes chronically.

MANAGEMENT: The combination of ethanol and barbiturates should be avoided.