Drug Interaction Report

GENERALLY AVOID: When administered systemically, horse chestnut may theoretically potentiate the effects of anticoagulants, platelet inhibitors and other agents that affect hemostasis, possibly increasing the risk of bleeding and bruising. Horse chestnut contains the coumarin glycosides aesculetin, fraxin, and scopolin.

MANAGEMENT: Patients should consult a healthcare provider before taking any herbal or alternative medicine. Until more information is available, consumption of horse chestnut should preferably be avoided during use of anticoagulants, platelet inhibitors, or other agents that can cause bleeding. In patients who have used horse chestnut extensively prior to receiving these agents, the potential for an interaction should be considered. Close clinical and laboratory monitoring for bleeding complications is recommended. Patients should be advised to promptly report any signs of unusual bleeding or bruising to their physician, including pain, swelling, headache, dizziness, weakness, nosebleeds, prolonged bleeding from cuts, bleeding of gums from brushing, red or brown urine, and red or black stools.

ADJUST DOSING INTERVAL: Food reduces the oral bioavailability of betrixaban. When administered with a low-fat (900 calories; 20% fat) or high-fat (900 calories; 60% fat) meal, betrixaban peak plasma concentration (Cmax) and systemic exposure (AUC) decreased relative to administration in the fasting state by an average of 70% and 61%, respectively, with the low-fat meal and 50% and 48%, respectively, with the high-fat meal. The effect of food on betrixaban pharmacokinetics could be observed for up to 6 hours after meal intake.

MANAGEMENT: The manufacturer recommends taking betrixaban at the same time each day with food.