<?xml version=“1.0” encoding=“UTF-8”?> <MedicinalProductInteraction xmlns=“hl7.org/fhir”>

<id value="example"/>
<meta>
  <security>
    <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
    <code value="HTEST"/>
    <display value="test health data"/>
  </security>
</meta>
<description value="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 value="http://ema.europa.eu/example/interactant"/>
      <code value="ketoconazole"/>
    </coding>
  </itemCodeableConcept>
</interactant>
<interactant>
  <itemCodeableConcept>
    <coding>
      <system value="http://ema.europa.eu/example/interactant"/>
      <code value="itraconazole"/>
    </coding>
  </itemCodeableConcept>
</interactant>
<type>
  <coding>
    <system value="http://ema.europa.eu/example/interactionsType"/>
    <code value="StrongInhibitorofCYP3A4"/>
  </coding>
</type>
<effect>
  <coding>
    <system value="http://ema.europa.eu/example/interactionseffect"/>
    <code value="Increasedplasmaconcentrations"/>
  </coding>
</effect>
<management>
  <text value="Coadministration not recommended in patients receiving concomitant systemic treatment strong inhibitors of both CYP3A4 and P-gp"/>
</management>

</MedicinalProductInteraction>