Antiarrhythmic agents and DOACs are often coadministered to decrease stroke risk secondary to arrhythmias. Amiodarone increases bleeding risk in patients taking rivaroxaban by inhibiting hepatic cytochrome P450 (CYP) 3A4 metabolism. When creatinine clearance is slightly low, rivaroxaban concentrations increase about 1.86-fold when combined with amiodarone, leading to the increased risk for bleeding. Phenytoin decreases levels of rivaroxaban by inducing CYP3A4 metabolism. Procainamide and dofetilide do not affect CYP3A4 metabolism.
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Cite this: Mary L. Windle. Rapid Rx Quiz: Dangerous Drug Combinations - Medscape - Mar 13, 2023.