Vorapaxar/Strong CYP3A4 Inhibitors; Protease Inhibitors Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Some medicines may slow down how quickly your body processes vorapaxar.

What might happen:

The amount of vorapaxar in your blood may increase, which may increase your risk of bleeding, including bleeding from your gums, nosebleeds, unusual bruising, or dark stools.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know right away that you are taking these medicines together. If you have any signs of bleeding, such as bleeding from your gums, nosebleeds, unusual bruising, or dark stools, contact your doctor right away.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Zontivity (vorapaxar) US prescribing information. Merck & Co., Inc. November, 2019.
  • 2.Kosoglou T, Statkevich P, Kumar B, Xuan F, Schiller JE, Johnson-Levonas AO, Young S, Cutler DL. The effect of multiple doses of ketoconazole or rifampin on the single- and multiple-dose pharmacokinetics of vorapaxar. J Clin Pharmacol 2013 May;53(5):540-9.
  • 3.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and- drug-interactions-table-substrates-inhibitors-and-inducers. Updated 11/14/2017.
  • 4.Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents Living with HIV. Department of Health and Human Services. Available at: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-a nd-adolescent-arv/whats-new March 23, 2023.
  • 5.Sporanox (itraconazole) US prescribing information. Janssen Pharmaceutica Products, L.P. February, 2024.
  • 6.This information is based on an extract from the Certara Drug Interaction Database (DIDB) Platform, Copyright Certara 1999-2023..

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.