Moderate
Established
描述
Diltiazem increases dabigatran plasma levels through P-glycoprotein inhibition, potentially raising bleeding risk without a change in INR (dabigatran has no INR to monitor).
机制
Dabigatran etexilate (prodrug) is a substrate of intestinal P-glycoprotein; diltiazem inhibits P-gp, increasing dabigatran absorption and systemic exposure.
临床意义
Dabigatran AUC increases approximately 20–40%; clinically significant in patients with renal impairment who already have reduced dabigatran clearance.
处理措施
Monitor for bleeding symptoms; consider dabigatran dose reduction in patients with moderate renal impairment who require diltiazem.