Major
Established
Description
Cyclosporine dramatically increases dabigatran exposure through P-gp inhibition, raising the risk of serious or life-threatening bleeding.
Mechanism
Dabigatran etexilate is a P-gp substrate; cyclosporine's potent P-gp inhibition increases dabigatran bioavailability by up to 200%.
Clinical Significance
Contraindicated in the EU; FDA label includes a strong warning. Bleeding risk is substantially and unpredictably elevated.
Management
Contraindicated; avoid combination entirely. Select an alternative anticoagulant (e.g., a low-molecular-weight heparin) in patients requiring cyclosporine.