Major
Amiodarone × Dabigatran
Class III antiarrhythmics (Vaughan Williams)×Direct thrombin inhibitor
Mechanism
Amiodarone blocks intestinal P-glycoprotein – the main route of dabigatran absorption and elimination. Dabigatran plasma levels rise by 30–60%; bleeding risk increases.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black stools, blood in urine. Risk is higher in renal impairment.
Management
With creatinine clearance above 50 mL/min, standard dabigatran 150 mg twice daily is acceptable. At clearance 30–50 mL/min, reduce to 110 mg twice daily. Below 30 mL/min, do not prescribe the combination; switch to warfarin or apixaban.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.