{
  "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"
      }
    ]
  }
}