Interactions with apixaban, dabigatran, edoxaban or rivaroxaban can result in increased risks of a bleed or thrombosis. We advise on management options.

Using our advice

DOAC interactions are generally mediated via the cytochrome P450 isoenzyme system (CYP) and/or permeability glycoprotein (P-gp). However, some interactions can occur with medicines which also impair haemostasis.

Before considering a specific interaction, ensure you are familiar with the following guidance regarding interactions with DOACs:

Understanding direct oral anticoagulant (DOAC) interactions

It is important to understand the risks, mechanisms of interactions and actions to take when prescribing medicines with DOACs.

Advice for specific medicines with DOACs

The SPS interactions advice has been developed from published evidence, literature reviews and expert opinion, where needed. It includes commonly asked questions on medicine interactions and is not comprehensive for all potential interactions with DOACs.

Antiarrhythmic medicines





Antiseizure medicines


Further information

Drug interactions: resources to support answering questions signposts to common resources for checking medicine interactions.

Primary care healthcare professionals can seek further advice from our Medicines Advice service if the information is not available on the SPS website, or if your clinical scenario is complex.

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