Apixaban with Oxcarbazepine Interaction Details
Brand Names Associated with Apixaban
- Apixaban
- Eliquis®
Brand Names Associated with Oxcarbazepine
- Oxcarbazepine
- Oxtellar XR®
- Trileptal®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 04, 2024
Interaction Effect
Decreased apixaban exposure and possible subtherapeutic anticoagulation which could lead to a thrombotic event
Interaction Summary
Concomitant use of apixaban with oxcarbazepine, a CYP3A4 inducer, may lead to reduced apixaban levels, especially in the presence of other drugs that may cause reduced apixaban levels, and should be undertaken with caution[1]. Avoid coadministration if possible [2]. Alternatively, consider the use of vitamin-K antagonists (VKA) in patients with the need for antiepileptic drug (AED) therapy since VKAs can be monitored with INR measurements. In cases where apixaban is unavoidable, select an AED without known influence on the activity of P-gp or CYP3A4 [3].
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of apixaban with oxcarbazepine, a CYP3A4 inducer, may lead to reduced apixaban levels, especially in the presence of other drugs that may cause reduced apixaban levels, and should be undertaken with caution[1]. Avoid coadministration if possible [2]. Alternatively, consider the use of vitamin-K antagonists (VKA) in patients with the need for antiepileptic drug (AED) therapy since VKAs can be monitored with INR measurements. In cases where rivaroxaban is unavoidable, select an AED without known influence on the activity of P-gp or CYP3A4 [3].
Mechanism Of Interaction
Induction of CYP3A4-mediated apixaban metabolism by oxcarbazepine and competitive p-glycoprotein binding
Literature Reports
A) In a retrospective study (N=131) of patients receiving oxcarbazepine (n=2) or other enzyme-inducing antiseizure medications (EI-ASM; n=22) concomitantly with direct oral anticoagulant (DOAC) therapy, 37.5% experienced DOAC concentrations below the therapeutic range compared with 9.3% who were not receiving oxcarbazepine or other enzyme-inducing antiseizure medications (OR, 5.82; 95% CI, 2.03 to 16.66). Coadministration of apixaban and an EI-ASM significantly reduced the median apixaban peak concentration compared with patients not receiving an EI-ASM (106 vs 150 nanograms/mL). Apixaban was used by 85% (111 patients) of patients within the study, however, some patients received rivaroxaban (14 patients) or dabigatran (6 patients) [2].
References
1 ) 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.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
2 ) Perlman A, Goldstein R, Choshen Cohen L, et al: Effect of enzyme-inducing antiseizure medications on the risk of sub-therapeutic concentrations of direct oral anticoagulants: a retrospective cohort study. CNS Drugs 2021; 35(3):305-316.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
3 ) Stollberger C & Finsterer J: Interactions between non-vitamin K oral anticoagulants and antiepileptic drugs. Epilepsy Res 2016; 126:98-101.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
Apixaban Overview
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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.
Oxcarbazepine Overview
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Oxcarbazepine (Trileptal) is used alone or in combination with other medications to control certain types of seizures in adults and children. Oxcarbazepine extended-release tablets (Oxtellar XR) are used in combination with other medications to control certain types of seizures in adults and children 6 years of age and older. Oxcarbazepine is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain.
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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.