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Treatment of Depression in Patients on Anticoagulation Therapy: Antidepressant-Rivaroxaban Drug Interactions

Carlos Clayton Tôrres Aguiar

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.