Klin Farmakol Farm. 2026;40(1):41-46 | DOI: 10.36290/far.2025.068

Interactions between ARTA drugs and orally administered anticoagulants

Kryštof Dobečka1, Anna Králová1, 2
1 Oddělení klinické farmacie, Fakultní nemocnice Královské Vinohrady, Praha
2 Ústav farmakologie, 3. lékařská fakulta, Univerzita Karlova, Praha

ARTA drugs, including enzalutamide, apalutamide, darolutamide, and abiraterone, are antiandrogenic agents used in the treatment of prostate cancer. These medications can induce or inhibit biotransformation enzymes and transporters, thereby affecting plasma concentrations and the efficacy of concomitantly administered drugs. This article examines the interactions between ARTA and orally administered anticoagulants such as apixaban, rivaroxaban, edoxaban, dabigatran, and warfarin. It outlines the mechanism of interactions between individual agents and summarizes the current state of knowledge on optimizing pharmacotherapy when combining ARTA with anticoagulants. The management of these drug interactions should always be tailored to the individual based on an assessment of the overall clinical context.

Keywords: prostate cancer, ARTA, anticoagulants, drug interactions.

Received: September 5, 2025; Revised: December 1, 2025; Accepted: December 2, 2025; Published: April 20, 2026  Show citation

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Dobečka K, Králová A. Interactions between ARTA drugs and orally administered anticoagulants. Klin Farmakol Farm. 2026;40(1):41-46. doi: 10.36290/far.2025.068.
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References

  1. Koudelková, M et al. Prostascreening.cz - Program časného záchytu karcinomu prostaty [online]. Praha: Ústav zdravotnických informací a statistiky ČR, 2024. [cit. 2025-08-22]. Available from: https://www.prostascreening.cz. Verze 1.0
  2. Ikushima S, Ono R, Fukuda K, et al. Trousseau's syndrome: cancer-associated thrombosis. Jpn J Clin Oncol. 2016;46(3):204-208. Go to original source... Go to PubMed...
  3. Khorana AA, Mackman N, Falanga A, et al. Cancer-associated venous thromboembolism. Nat Rev Dis Primers. 2022;8(1):11. Go to original source... Go to PubMed...
  4. Leblanc K, Edwards SJ, Dranitsaris G, et al. Drug Interactions between Androgen Receptor Axis-Targeted Therapies and Antithrombotic Therapies in Prostate Cancer: Delphi Consensus. Cancers (Basel). 2024;16(19):3336. Go to original source... Go to PubMed...
  5. Dai C, Dehm SM, Sharifi N. Targeting the Androgen Signaling Axis in Prostate Cancer. J Clin Oncol. 2023;41(26):4267-4278. Go to original source... Go to PubMed...
  6. Gregorová J, Tašková I. Antikoagulační terapie. Praha: Max­dorf; 2022.
  7. American Cancer Society. Cancer Facts & Figures 2024. Atlanta: American Cancer Society; 2024.
  8. Chen Y, Zhou Q, Hankey W, et al. Second generation androgen receptor antagonists and challenges in prostate cancer treatment. Cell Death Dis. 2022;13(7):632. Go to original source... Go to PubMed...
  9. Soumarová R. Onkologie. Praha: Univerzita Karlova, nakladatelství Karolinum; 2025.
  10. Tran C, Ouk S, Clegg NJ, et al. Development of a second-generation antiandrogen for treatment of advanced prostate cancer. Science. 2009;324(5928):787-790. Go to original source... Go to PubMed...
  11. Souhrn údajů o přípravku (SPC) - Xtandi; 2025
  12. Clegg NJ, Wongvipat J, Joseph JD, et al. ARN-509: a novel antiandrogen for prostate cancer treatment. Cancer Res. 2012;72(6):1494-503. Go to original source... Go to PubMed...
  13. de Vries R, Jacobs F, Mannens G, et al. Apalutamide Absorption, Metabolism, and Excretion in Healthy Men, and Enzyme Reaction in Human Hepatocytes. Drug Metab Dispos. 2019;47(5):453-464. Go to original source... Go to PubMed...
  14. Duran I, Carles J, Bulat I, et al. Pharmacokinetic Drug-Drug Interaction of Apalutamide, Part 1: Clinical Studies in Healthy Men and Patients with Castration-Resistant Prostate Cancer. Clin Pharmacokinet. 2020;59(9):1135-1148. Go to original source... Go to PubMed...
  15. Moilanen AM, Riikonen R, Oksala R, et al. Discovery of ODM-201, a new-generation androgen receptor inhibitor targeting resistance mechanisms to androgen signaling-directed prostate cancer therapies. Sci Rep. 2015;5:12007. Go to original source... Go to PubMed...
  16. Zurth C, Koskinen M, Fricke R, et al. Drug-Drug Interaction Potential of Darolutamide: In Vitro and Clinical Studies. Eur J Drug Metab Pharmacokinet. 2019;44(6):747-759. Go to original source... Go to PubMed...
  17. Shore N, Zurth Ch, Fricke R, et al. Evaluation of Clinically Relevant Drug-Drug Interactions and Population Pharmacokinetics of Darolutamide in Patients with Nonmetastatic Castration-Resistant Prostate Cancer: Results of Pre-Specified and Post Hoc Analyses of the Phase III ARAMIS Trial. Target Oncol. 2019;14(5):527-539. Go to original source... Go to PubMed...
  18. Danila DC, Morris MJ, de Bono JS, et al. Phase II multicenter study of abiraterone acetate plus prednisone therapy in patients with docetaxel-treated castration-resistant prostate cancer. J Clin Oncol. 2010;28(9):1496-501. Go to original source... Go to PubMed...
  19. Han CS, Patel R, Kim IY. Pharmacokinetics, pharmacodynamics and clinical efficacy of abiraterone acetate for treating metastatic castration-resistant prostate cancer. Expert Opin Drug Metab Toxicol. 2015;11(6):967-975. Go to original source... Go to PubMed...
  20. Montgomery RB, Vessella R, Mostaghel E, et al. Maintenance of intratumoral androgens in metastatic prostate cancer: a mechanism for castration-resistant tumor growth. Cancer Res. 2008;68(11):4447-4454. Go to original source... Go to PubMed...
  21. Ando T, Nishiyama T, Takizawa I, et al. Dihydrotestosterone synthesis pathways from inactive androgen 5α-androstane-3β,17β-diol in prostate cancer cells: Inhibition of intratumoural 3β-hydroxysteroid dehydrogenase activities by abiraterone. Sci Rep. 2016;6:32198. Go to original source... Go to PubMed...
  22. Li R, Evaul K, Sharma KK, et al. Abiraterone inhibits 3β-hydroxysteroid dehydrogenase: a rationale for increasing drug exposure in castration-resistant prostate cancer. Clin Cancer Res. 2012;18(13):3571-3579. Go to original source... Go to PubMed...
  23. Acharya M, Bernard A, Gonzalez M, et al. Open-label, phase I, pharmacokinetic studies of abiraterone acetate in healthy men. Cancer Chemother Pharmacol. 2012;69(6):1583-1590. Go to original source... Go to PubMed...
  24. Souhrn údajů o přípravku (SPC) - Zytiga; 2025.
  25. Büchler T. Klinická onkologie. Praha: Maxdorf; 2023.
  26. Ferri N, Colombo E, Tenconi M, et al. Drug-Drug Interactions of Direct Oral Anticoagulants (DOACs): From Pharmacological to Clinical Practice. Pharmaceutics. 2022;14(6):1120. Go to original source... Go to PubMed...
  27. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. Go to original source... Go to PubMed...
  28. Arachchillage DJ, Platton S, Hickey K, et al. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol. 2024;205(3):855-880. Go to original source... Go to PubMed...
  29. Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146-153. Go to original source... Go to PubMed...
  30. Meyer G. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med. 2002;162(15):1729-1735. Go to original source... Go to PubMed...
  31. Lee YJ, Park J-K, Uhm J-S, et al. Bleeding risk and major adverse events in patients with cancer on oral anticoagulation therapy. Int J Cardiol. 2016;203:372-378. Go to original source... Go to PubMed...
  32. Giustozzi M, Agnelli G, Del Toro-Cervera J, et al. Direct Oral Anticoagulants for the Treatment of Acute Venous Thromboembolism Associated with Cancer: A Systematic Review and Meta-Analysis. Thromb Haemost. 2020;120(7):1128-1136. Go to original source... Go to PubMed...
  33. Sabatino J, De Rosa S, Polimeni A, et al. Direct Oral Anticoagulants in Patients With Active Cancer: A Systematic Review and Meta-Analysis. JACC CardioOncol. 2020;2(3):428-440. Go to original source... Go to PubMed...
  34. Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med. 2018;378(7):615-624. Go to original source... Go to PubMed...
  35. Agnelli G, Becattini C, Meyer G, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N Engl J Med. 2020;382(17):1599-1607. Go to original source... Go to PubMed...
  36. Górnicki T, Bułdyś K, Zielińska D, et al. Direct-Acting Oral Anticoagulant Therapy in Cancer Patients-A Review. Cancers (Basel). 2023;15(10):2697. Go to original source... Go to PubMed...
  37. Kraaijpoel N, Carrier M. How I treat cancer-associated venous thromboembolism. Blood. 2019;133(4):291-298. Go to original source... Go to PubMed...
  38. Hindley B, Lip GYH, McCloskey AP, et al. Pharmacokinetics and pharmacodynamics of direct oral anticoagulants. Expert Opin Drug Metab Toxicol. 2023;19(12):911-923. Go to original source... Go to PubMed...
  39. Souhrn údajů o přípravku (SPC) - Pradaxa; 2025
  40. Byon W, Garonzik S, Boyd RA, et al. Apixaban: A Clinical Pharmacokinetic and Pharmacodynamic Review. Clin Pharmacokinet. 2019;58(10):1265-1279. Go to original source... Go to PubMed...
  41. Souhrn údajů o přípravku (SPC) - Eliquis; 2025.
  42. Kvasnička T, Malikova I, Zenahlikova Z, et al. Rivaroxaban - Metabolism, Pharmacologic Properties and Drug Interactions. Curr Drug Metab. 2017;18(7):636-642. Go to original source... Go to PubMed...
  43. Souhrn údajů o přípravku (SPC) - Xarelto; 2025.
  44. Souhrn údajů o přípravku (SPC) - Lixiana; 2025.
  45. Mar PL, Gopinathannair R, Gengler BE, et al. Drug Interactions Affecting Oral Anticoagulant Use. Circ Arrhythm Electrophysiol. 2022;15(6):e007956. Go to original source... Go to PubMed...
  46. Souhrn údajů o přípravku (SPC) - Warfarin Orion; 2025.
  47. Shatzel JJ, Daughety MM, Olson SR, et al. Management of Anticoagulation in Patients With Prostate Cancer Receiving Enzalutamide. J Oncol Pract. 2017;13(11):720-727. Go to original source... Go to PubMed...
  48. Otsuka Y, Poondru S, Bonate PL, et al. Physiologically-based pharmacokinetic modeling to predict drug-drug interaction of enzalutamide with combined P-gp and CYP3A substrates. J Pharmacokinet Pharmacodyn. 2023;50(5):365-376. Go to original source... Go to PubMed...
  49. Lennep BW, Mack J, Poondru S, et al. Enzalutamide: Under­standing and Managing Drug Interactions to Improve Patient Safety and Drug Efficacy. Drug Saf. 2024;47(7):617-641. Go to original source... Go to PubMed...
  50. Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021;23(10):1612-1676. Go to original source... Go to PubMed...
  51. Gibbons JA, de Vries M, Krauwinkel W, et al. Pharmacokinetic Drug Interaction Studies with Enzalutamide. Clin Pharmacokinet. 2015;54(10):1057-1069. Go to original source... Go to PubMed...
  52. Parrett JL, Reaves AB, Self TH, et al. Enzalutamide-warfarin interaction necessitating warfarin dosage adjustment: A case report of successful clinical management. J Clin Pharm Ther. 2018;43(2):276-279. Go to original source... Go to PubMed...
  53. Casserly EA, Rogers SE, Keisner SV. Lack of interaction between enzalutamide and warfarin in a metastatic castration-resistant prostate cancer patient. J Oncol Pharm Pract. 2017;23(1):68-70. Go to original source... Go to PubMed...
  54. Potdar R, Gartrell BA, Given R, et al. Concomitant use of oral anticoagulants in patients with advanced prostate can­cer receiving apalutamide: A post-hoc analysis of TITAN and SPARTAN studies. Am J Cancer Res. 2022;12(1):445-450.
  55. Souhrn údajů o přípravku (SPC) - Erleada; 2025.
  56. Podgoršek E, Mehra N, van Oort IM, et al. Clinical Pharmacokinetics and Pharmacodynamics of the Next Generation Androgen Receptor Inhibitor-Darolutamide. Clin Pharmacokinet. 2023;62(8):1049-1061. Go to original source... Go to PubMed...
  57. Boujonnier F, Lemaitre F, Scailteux LM. Pharmacokinetic Interactions Between Abiraterone, Apalutamide, Darolutamide or Enzalutamide and Antithrombotic Drugs: Prediction of Clinical Events and Review of Pharmacological Information. Cardiovasc Drugs Ther. 2024;38(4):757-767. Go to original source... Go to PubMed...
  58. Souhrn údajů o přípravku (SPC) - Nubeqa; 2025.
  59. Benoist GE, Hendriks RJ, Mulders PFA, et al. Pharmacokinetic Aspects of the Two Novel Oral Drugs Used for Metastatic Castration-Resistant Prostate Cancer: Abiraterone Acetate and Enzalutamide. Clin Pharmacokinet. 2016;55(11):1369-1380. Go to original source... Go to PubMed...
  60. Monbaliu J, Gonzalez M, Bernard A, et al. In Vitro and In Vivo Drug-Drug Interaction Studies to Assess the Effect of Abiraterone Acetate, Abiraterone, and Metabolites of Abiraterone on CYP2C8 Activity. Drug Metab Dispos. 2016;44(10):1682-1691. Go to original source... Go to PubMed...
  61. Dubinsky S, Thawer A, McLeod AG, et al. Management of anticoagulation in patients with metastatic castration-resistant prostate cancer receiving abiraterone + prednisone. Support Care Cancer. 2019;27(9):3209-3217. Go to original source...
  62. Mithoowani S, Tan CW, Siegal DM. Measuring Direct Oral Anticoagulant (DOAC) Levels: Applications, Limitations, and Future Directions. Int J Lab Hematol. 2025 Apr 22.




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