Date of report: 28 Jul 2020
Reported case interaction between
Dolutegravir and Apixaban

FLS Science

Drugs suspected to be involved in the DDI

Drug A
Dolutegravir (Perpetrator)
Daily Dose
50 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Jan. 10, 2018
End date
Ongoing
Drug B
Apixaban (Victim)
Daily Dose
10 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Jan. 10, 2018
End date
Ongoing

Complete list of drugs taken by the patient

Antiretroviral treatment
Emtricitabine/Tenofovir-AF
Dolutegravir
Complete list of all comedications taken by the patient, included that involved in the DDI
Apixaban, lanzoprazole, aspirin, finasteride, pravastatin, tamsulosin

Clinical case description

Gender
Male
Age
80
eGFR (mL/min)
>60
Liver function impairment
No
Description
This patient is a person living with HIV/HBV since 1995. He was on treatment with darunavir/ritonavir and lamivudine until he suffered from unstable angina and underwent coronary artery bypass surgery in 2016, complicated with acute myocardial infarction and atrial fibrillation. His treatment was then switched to tenofovir alafenamide/emtricitabine, and dolutegravir and apixaban was maintained. No recurrence in AMI nor new ischemic stroke was observed. No major bleeding occurred in the follow up (last visit December 2019).

Outcome

No unwanted outcome

Editorial Comment

Based on metabolism and clearance a clinically significant interaction is unlikely. Apixaban is metabolized by CYP3A4 and to a lesser extent CYP1A2, CYP2C8, CYP2C9 and CYP2C19, but dolutegravir is mainly metabolized by UGT1A1.