CriticalDirect thrombin inhibitor×Class III antiarrhythmic
Updated · Methodology
Mechanism
Dronedarone strongly inhibits intestinal P-glycoprotein, the clearance route of dabigatran. Dabigatran plasma levels rise 2-fold or more. FDA Multaq Section 4.3 specifically lists dabigatran etexilate as an absolute contraindication.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage, gross haematuria with renal colic, spontaneous retroperitoneal haematomas. Symptoms may appear within days of co-prescription.
Management
The combination is not prescribed. For atrial fibrillation patients on dronedarone, anticoagulate with warfarin, apixaban, or rivaroxaban (the latter two use P-glycoprotein less and are acceptable without dose change).
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- ESC: 2020 ESC Guidelines for the management of atrial fibrillation (2020)
- FDA: Multaq (dronedarone) prescribing information (2020)– ; DailyMed setid 7fa41601-7fb5-4155-8e50-2ae903f0d2d6
- AEMPS: Ficha técnica: Dabigatrán etexilato (nº registro 86841), sección 4.5 (2026)– AEMPS, CIMA, nº registro 86841, sección 4.5
- AEMPS: Ficha técnica: Dronedarona (nº registro 84320), sección 4.3 (2025)– AEMPS, CIMA, nº registro 84320, revisión 10/2025, sección 4.3