Apixaban with Levothyroxine Interaction Details

Brand Names Associated with Apixaban

  • Apixaban
  • Eliquis®

Brand Names Associated with Levothyroxine

  • Levo-T®
  • Levothroid®
  • Levothyroxine
  • Levoxyl®
  • Synthroid®
  • Tirosint®
  • Unithroid®

Medical Content Editor
Last updated Mar 04, 2024

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Interaction Effect

Increased response to oral anticoagulant therapy

Interaction Summary

Concomitant use of levothyroxine and oral anticoagulants increases the response to oral anticoagulant therapy. Therefore, a decrease in the dose of anticoagulant may be warranted with correction of the hypothyroid state or when the levothyroxine dose is increased. Closely monitor coagulation tests for appropriate and timely dosage adjustments[1].

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant use of levothyroxine and oral anticoagulants increases the response to oral anticoagulant therapy. Therefore, a decrease in the dose of anticoagulant may be warranted with correction of the hypothyroid state or when the levothyroxine dose is increased. Closely monitor coagulation tests for appropriate and timely dosage adjustments[1].

Mechanism Of Interaction

Unknown

Literature Reports

A) In a retrospective study in adults receiving stable warfarin (N=102; mean age 73.9 years; 51.3% with atrial fibrillation or flutter), initiation of levothyroxine resulted in no significant change in the mean warfarin dose/INR ratio during a 90-day followup (12.9 preexposure vs 13.5 postexposure). The mean warfarin dose/INR ratio was also not significantly different between pre and post exposure in patients who achieved euthyroidism following concomitant use (13.42 preexposure vs 12.7 postexposure) [2].

B) Elderly patients on concomitant levothyroxine and warfarin therapy did not have an increased risk of hospitalization due to hemorrhage compared with controls. The risk of hemorrhage due to the concomitant use of levothyroxine was evaluated in a 16-year population-based nested case-control analysis involving older patients (n=10,532) with a median age of 80 years (interquartile range, 75 to 86 years) who received warfarin for at least 3 months and were hospitalized due to hemorrhage (case patients). Control patients were on warfarin and were not hospitalized for hemorrhage (n=40,693). There was a nonsignificant 11% increased risk of hemorrhage in case patients initiating levothyroxine within 30 days of the date of the first hospital admission for hemorrhage. There was also no significant association with more distant exposures for case patients initiating levothyroxine 31 to 60 days (decrease 24%) or 61 to 90 days (decreased 33%) prior to the index date [3].

References

    1 ) Product Information: TIROSINT(R)-SOL oral solution, levothyroxine sodium oral solution. IBSA Pharma Inc. (per FDA), Parsippany, NJ, 2023.

    2 ) Wood MD, Delate T, Clark M, et al: An evaluation of the potential drug interaction between warfarin and levothyroxine. J Thromb Haemost 2014; 12(8):1313-1319.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

    3 ) Pincus D, Gomes T, Hellings C, et al: A population-based assessment of the drug interaction between levothyroxine and warfarin. Clin Pharmacol Ther 2012; 92(6):766-770.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

Apixaban Overview

  • Apixaban is used help prevent strokes or blood clots in people who have atrial fibrillation (a condition in which the heart beats irregularly, increasing the chance of clots forming in the body and possibly causing strokes) that is not caused by heart valve disease. Apixaban is also used to prevent deep vein thrombosis (DVT; a blood clot, usually in the leg) and pulmonary embolism (PE; a blood clot in the lung) in people who are having hip replacement or knee replacement surgery. Apixaban is also used to treat DVT and PE and may be continued to prevent DVT and PE from happening again after the initial treatment is completed. Apixaban is in a class of medications called factor Xa inhibitors. It works by blocking the action of a certain natural substance that helps blood clots to form.

See More information Regarding Apixaban

Levothyroxine Overview

  • Levothyroxine is used to treat hypothyroidism (condition where the thyroid gland does not produce enough thyroid hormone). It is also used with surgery and radioactive iodine therapy to treat thyroid cancer. Levothyroxine is in a class of medications called hormones. It works by replacing thyroid hormone that is normally produced by the body.

  • Without thyroid hormone, your body cannot function properly, which may result in poor growth, slow speech, lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression. When taken correctly, levothyroxine reverses these symptoms.

See More information Regarding Levothyroxine

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.


Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.


Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.


Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.