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Carbamazepine Induction Impacting Apixaban Concentrations: A Case Report.
Tammy J Bungard1, R Neil Roberts2
1Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
CJC Open
|September 30, 2020
Summary
Avoid combining apixaban with carbamazepine (CBZ) due to reduced apixaban levels. Dose adjustments may be needed, and monitoring apixaban concentration is crucial when these drugs are used together.
Area of Science:
- Pharmacology
- Drug Interactions
- Clinical Pharmacy
Background:
- Apixaban is an anticoagulant, and carbamazepine (CBZ) is an anticonvulsant and mood-stabilizing drug.
- A potential drug interaction between apixaban and CBZ is anticipated, leading to reduced apixaban concentrations.
- The clinical significance and time course of this interaction are not well-documented.
Observation:
- A patient receiving apixaban experienced a significant reduction in apixaban concentration after initiating carbamazepine (CBZ).
- Apixaban levels were measured before and two weeks after CBZ initiation.
- The reduction in apixaban concentration appeared to be dose-dependent on CBZ and occurred over a 2-4 week period.
Findings:
- The study documented a substantial decrease in apixaban concentrations following the introduction of CBZ.
- To maintain therapeutic levels, the apixaban dose was doubled, with a minor increase in CBZ dosage.
- Subsequent apixaban concentrations remained stable after dose adjustment, indicating a manageable interaction when monitored.
Implications:
- The findings highlight a clinically significant drug interaction between apixaban and carbamazepine.
- This interaction necessitates careful consideration and monitoring of apixaban concentrations when co-administered with CBZ.
- Avoidance of this combination is recommended unless therapeutic drug monitoring of apixaban is feasible using a validated assay.
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