Interaction Xarelto et Amiodarone

Interaction via inhibition de la glycoprotéine-P, l'amiodarone augmente l'absorption du Xarelto qui est un substrat.

Suggestion selon Vigilance: surveiller étroitement les saignements.

Sur Micromedex:

The concomitant use of amiodarone, a CYP3A4 and P-glycoprotein inhibitor, and rivaroxaban may cause increased rivaroxaban plasma concentrations and increase the risk of bleeding especially in renally impaired patients. Although no formal drug-interaction studies have been done with amiodarone, in drug-interaction studies of the coadministration of erythromycin, a moderate CYP3A4 and P-glycoprotein inhibitor, and rivaroxaban resulted in a 30% increase in rivaroxaban AUC and Cmax. In the ROCKET AF trial, the concomitant use of rivaroxaban and combined P-glycoprotein and weak or moderate CYP3A4 inhibitors did not result in increased bleeding in patients with CrCl between 30 to less than 50 mL/min (Hazard Ratio 1.05; 95% CI, 0.77 to 1.42). Therefore the concomitant use of rivaroxaban and amiodarone should be used with caution in patients with CrCl between 15 and 50 mL/min and only if the potential benefit outweighs the potential risk.

Donc, attention principalement si clairance entre 15 et 50ml/min.