Alogliptin and Dabigatran Etexilate: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Alogliptin
Dabigatran Etexilate
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased dabigatran exposure and an increased risk of bleeding
Interaction Deep Dive
Concomitant use of dabigatran and a P-gp inhibitor may increase dabigatran exposure and risk of bleeding, therefore coadministration should generally be avoided2, particularly in renal impaired patients. In adult patients, avoid concomitant use of dabigatran capsules for stroke and systemic embolism risk reduction in non-valvular atrial fibrillation if CrCl is 15 to 30 mL/min. Also, avoid concomitant use of dabigatran capsules for treatment of, recurrence risk reduction of, or prophylaxis of DVT or pulmonary embolism (PE) post-hip surgery if CrCl is less than 50 mL/min. If CrCl is 50 mL/min or greater, separate administration by several hours for prophylaxis. Concomitant use of dabigatran with P-gp inhibitors has not been studied in pediatric patients but may increase dabigatran exposure 1. Caution may be necessary with coadministration of dabigatran and moderate to strong P-gp inhibitors regardless of kidney function 3.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of dabigatran
Literature reports
2 reports — tap to read
a) A 76-year-old woman taking dabigatran 150 mg twice daily for bilateral lower extremity DVTs and low-dose quiNIDine (10 mg twice daily) for an unknown indication was admitted from a nursing home with abdominal pain and rectal bleeding. On admission she was found to have anemia (Hb, 4.9 g/dL) and coagulopathy (thrombin time (TT) greater than 60 seconds), with acute kidney injury (SCr of 2 mg/dL; baseline 0.8 mg/dL), and an elevated BUN at 90 mg/dL. She was diagnosed with acute blood loss anemia secondary to lower GI bleeding likely related to dabigatran use. Bleeding risk associated with catheter placement precluded initiation of hemodialysis. Transfusion measures and treatment with idaruCIZUmab initially normalized the patient's Hb (8.2 g/dL) and TT (14.3 seconds), but she experienced rebleeding, and the TT returned to greater than 60 seconds when rechecked approximately 20 hours after administration of idaruCIZUmab. A 10-day hospitalization for persistent coagulopathy, rectal bleeding, and renal impairment was necessary, and the patient received 2 additional doses of idaruCIZUmab on hospital days 2 and 4, with each treatment providing only temporary normalization of coagulation parameters. The patient continued to have rectal bleeding until day 5 at which point it began to improve, however TT remained elevated until hospital day 9. While renal impairment may have contributed to reduced dabigatran clearance in this case, quiNIDine (a P-gp inhibitor), was thought to have contributed to the initial suspected supratherapeutic levels of dabigatran 4.
b) In a comparative effectiveness study of patients with nonvalvular atrial fibrillation and normal kidney function, the overall bleeding rate was 52% higher (244.9 vs 158.4 per 1000 person-years; HR, 1.52; 95% CI, 1.05 to 2.2) with coadministration of dabigatran and verapamil or dilTIAZem (n=750) compared with coadministration with amLODIPine (n=1316), and 43% higher (291.3 vs 199.7 per 1000 patient-years; HR, 1.43; 95% CI, 1.02 to 2) with dabigatran and verapamil or dilTIAZem (n=764) compared with metoprolol (n=1334). Additionally, overall gastrointestinal (GI) bleeding (HR, 2.16; 95% CI, 1.3 to 3.6), minor bleeding (HR, 1.56; 95% CI, 1.07 to 2.27) and GI minor bleeding (HR, 2.16; 95% CI, 1.29 to 3.63) were also significantly increased with dabigatran and verapamil or dilTIAZem compared with amLODIPine, and overall GI bleeding (HR, 2.32; 95% CI, 1.42 to 3.79), major/moderate bleeding (HR, 3.32; 1.54 to 7.16), major/moderate GI bleeding (HR, 5.49; 95% CI, 1.67 to 18.03), and GI minor bleeding (HR, 2.33; 95% CI, 1.42 to 3.82) were significantly increased with dabigatran and verapamil or dilTIAZem compared with metoprolol. Patients received dabigatran 150 mg twice daily. Caution may be necessary with coadministration of dabigatran with verapamil and dilTIAZem, and possibly other moderate to strong P-gp inhibitors, regardless of kidney function 3.
Common questions
Can I take Alogliptin and Dabigatran Etexilate together?
Increased dabigatran exposure and an increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Alogliptin and Dabigatran Etexilate interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Alogliptin or Dabigatran Etexilate need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: PRADAXA(R) oral capsules, dabigatran etexilate oral capsules. Boehringer Ingelheim Pharmaceuticals Inc (per FDA), Ridgefield, CT, 2023. DailyMed
- 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.
- Pham P, Schmidt S, Lesko L, et al: Association of oral anticoagulants and verapamil or diltiazem with adverse bleeding events in patients with nonvalvular atrial fibrillation and normal kidney function. JAMA Netw Open 2020; 3(4):e203593-. DOI
- George S, Taburyanskaya M, & Lewis V: Probable drug-drug interaction between dabigatran and quinidine resulting in thrombin time rebound despite multiple idarucizumab doses. Blood Coagul Fibrinolysis 2019; 30(1):42-46. PubMed
Keep reading about Alogliptin
Keep reading about Dabigatran Etexilate
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