Abstract
The use of Oral Anticoagulants (OAC) is recommended for stroke prevention. Rivaroxaban is a new generation oral anticoagulant. Depression and anxiety are psychiatric disorders which frequently coexist with the Coronary Artery Disease (CAD) and other cardiovascular diseases. In the last decades, there has been an increase in the use of antidepressants. This literature review aims to provide a general view of pharmacokinetic knowledge of drug interactions between rivaroxaban and antidepressants. Since rivaroxaban is metabolized by CYP3A4, the use of antidepressants that are inhibitors of this isoenzyme, such as fluoxetine, sertraline, paroxetine and fluvoxamine must be avoided. Based on drug interactions in cytochrome p450, it has been concluded that the use of escitalopram, citalopram, venlafaxine, mirtazapine or milnacipran would be safer in these patients since these drugs have a minimum CYP 450 inhibition potential.
Highlights
For many years, vitamin K antagonists were the only available oral anticoagulants for clinical use
Rivaroxaban is an example of the new oral anticoagulants (Figure 1) [3]
CYP3A4 accounts for approximately 18% and CYP2J2 for approximately 14% of rivaroxaban total excretion
Summary
Vitamin K antagonists were the only available oral anticoagulants for clinical use. Rivaroxaban is metabolized by CYP3A4, CYP2J2 and by CYP independent mechanisms. CYP3A4 accounts for approximately 18% and CYP2J2 for approximately 14% of rivaroxaban total excretion. Sick elderly presented higher plasma concentrations than younger patients, with 1.5 times higher levels, due mainly to a reduction (apparent) in the total and renal depuration rate [1].
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