{

"resourceType": "MedicinalProductInteraction",
"id": "example",
"description": "Inhibitors of CYP3A4 and P-gp\\nCoadministration of equixaban with ketoconazole (400 mg once a day), a strong inhibitor of both\\nCYP3A4 and P-gp, led to a 2-fold increase in mean equixaban AUC and a 1.6-fold increase in mean\\nequixaban Cmax.\\nThe use of Eliquis is not recommended in patients receiving concomitant systemic treatment with\\nstrong inhibitors of both CYP3A4 and P-gp, such as azole-antimycotics (e.g., ketoconazole,\\nitraconazole, voriconazole and posaconazole) and HIV protease inhibitors (e.g., ritonavir) (see\\nsection 4.4).\\nActive substances which are not considered strong inhibitors of both CYP3A4 and P-gp,\\n(e.g., diltiazem, naproxen, amiodarone, verapamil, quinidine) are expected to increase equixaban\\nplasma concentration to a lesser extent. Diltiazem (360 mg once a day), for instance, considered a moderate CYP3A4 and a weak P-gp inhibitor, led to a 1.4-fold increase in mean equixaban AUC and a 1.3-fold increase in Cmax. Naproxen (500 mg, single dose) an inhibitor of P-gp but not an inhibitor of CYP3A4, led to a 1.5-fold and 1.6-fold increase in mean equixaban AUC and Cmax, respectively. No dose adjustment for equixaban is required when coadministered with less potent inhibitors of CYP3A4 and/or P-gp.",
"interactant": [
  {
    "itemCodeableConcept": {
      "coding": [
        {
          "system": "http://ema.europa.eu/example/interactant",
          "code": "ketoconazole"
        }
      ]
    }
  },
  {
    "itemCodeableConcept": {
      "coding": [
        {
          "system": "http://ema.europa.eu/example/interactant",
          "code": "itraconazole"
        }
      ]
    }
  }
],
"type": {
  "coding": [
    {
      "system": "http://ema.europa.eu/example/interactionsType",
      "code": "StrongInhibitorofCYP3A4"
    }
  ]
},
"effect": {
  "coding": [
    {
      "system": "http://ema.europa.eu/example/interactionseffect",
      "code": "Increasedplasmaconcentrations"
    }
  ]
},
"management": {
  "text": "Coadministration not recommended in patients receiving concomitant systemic treatment strong inhibitors of both CYP3A4 and P-gp"
},
"meta": {
  "tag": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code": "HTEST",
      "display": "test health data"
    }
  ]
}

}