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Pol. Merkur. Lek (Pol. Med. J.), 2015, XXXIX/232: 227-230 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2015, XXXIX/232: 227-230

Title: Hemoptysis during concomitant treatment with rivaroxaban and amiodarone in a patient with a history of pulmonary disease 

Authors: Elikowski W, Małek M, Skowroński M, Wróblewski D, Skrzywanek P, Zawilska K. 

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN POLISH.

Hemoptysis during concomitant treatment with rivaroxaban and amiodarone in a patient with a history of pulmonary disease


Elikowski W1, Małek M1, Skowroński M2, Wróblewski D1, Skrzywanek P3, Zawilska K4.

1Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland: 2Wielkopolska Center of Pulmonology and Thoracic Surgery, Ludwikowo, n. Poznań, Poland, 3Radiology Unit, Józef Struś Hospital, Poznań, Poland, 4Hemostasis Laboratory, Diagnostic and Therapeutic Center Interlab, Poznań

Rivaroxaban, a selective inhibitor of active factor X, is metabolized by cytochrom P450 3A4 (CYP3A4) and is a substrate for transporter protein – P-glycoprotein (P-gp). Amiodarone, an antiarrhytmic agent, is classified as moderate CYP3A4 and P-gp inhibitor.
A case report
. A 75-year-old male, who underwent lobectomy for bronchiectasis many years ago, is presented. For one year the patient was treated with rivaroxaban (20 mg/d) due to venous thromboembolism and recurrent episodes of atrial fibrillation. Two weeks after amiodarone initiation (200 mg/d) hemoptysis occurred and computed tomography revealed unilateral pulmonary infiltrates with ground-glass opacities limited to the lower lobe of the left lung. The symptoms disappeared following discontinuation of the two medications and did not recur while rivaroxaban was reintroduced in a dose of 15 mg/d; measurement of anti-Xa activity confirmed it as a therapeutic dose. Amiodarone, that had been used for a short time and well tolerated a few years before, was definitely withdrawn.
Conclusions
. The authors suggest, that the concomitant use of rivaroxaban and amiodarone should be very careful in patients with a history of pulmonary disease.

Key words: hemoptysis, rivaroxaban, amiodarone, history of pulmonary disease

Pol Med J, 2015; XXXIX (232); 227–230