Apixaban with Posaconazole Interaction Details
Brand Names Associated with Apixaban
- Apixaban
- Eliquis®
Brand Names Associated with Posaconazole
- Noxafil PowderMix®
- Noxafil®
- Posaconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 04, 2024
Interaction Effect
Increased exposure of apixaban
Interaction Summary
Concomitant use of apixaban and posaconazole may increase apixaban exposure and is not recommended. Apixaban is a CYP3A4 and P-glycoprotein (P-gp) substrate; posaconazole is a strong CYP3A4 inhibitor and possible P-gp inhibitor[1]. Monitor closely if coadministration is necessary [2].
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of apixaban and posaconazole may increase apixaban exposure and is not recommended. Apixaban is a CYP3A4 and P-glycoprotein (P-gp) substrate; posaconazole is a strong CYP3A4 inhibitor and possible P-gp inhibitor[1]. Monitor closely if coadministration is necessary [2].
Mechanism Of Interaction
Inhibition of CYP3A4-mediated metabolism by posaconazole; possible inhibition of P-glycoprotein-mediated efflux transport by posaconazole
Literature Reports
A) In a study evaluating data from the Food and Drug Administration Adverse Event Reporting System (FAERS), adverse events associated with direct oral anticoagulants (DOACs) used concomitantly with CYP3A4 inhibitors (including macrolide antibiotics and azole antimycotics) were pooled to identify signals of hemorrhages. From 2010 to 2021, 1128 cases of bleeding associated with coadministration of CYP3A4 inhibitors and DOACs were identified, including cases with rivaroxaban (529 events), apixaban (315 events), dabigatran (296 events), and edoxaban (19 events); no cases were reported with betrixaban. Patients were a median age of 73 years (range, 61 to 81 years). Hemorrhagic signals were expressed by reporting odds ratios (RORs) and 95% confidence intervals and considered significant when the lower limit of 95% CI was greater than 1 and the number of interaction group was 3 or more. Subgroup analyses and logistic regression were conducted by adjusting associated factors in hemorrhagic events. The hemorrhagic signal was significant for apixaban when coadministered with posaconazole compared with apixaban treatment alone (ROR, 2.69; 95% CI, 1.37 to 5.28) [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 ) Li D, Yan C, Guo M, et al: Evidence of potential pro-haemorrhagic drug interactions between CYP3A4 inhibitors and direct oral anticoagulants: analysis of the FAERS database. Br J Clin Pharmacol 2023; 89(8):2423-2429.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.
Posaconazole Overview
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Posaconazole is used to prevent serious fungal infections that can spread throughout the body in adults and children 2 years of age and older with a weakened ability to fight infection. Posaconazole delayed-release tablets are used to treat invasive aspergillosis (a serious fungal infection that begins in the lungs and spreads through the bloodstream to other organs) in adults and teenagers 13 years of age and older. Posaconazole oral suspension is also used to treat yeast infections of the mouth and throat including yeast infections in adults and teenagers 13 years of age and older that could not be treated successfully with other medications. Posaconazole is in a class of medications called azole antifungals. It works by slowing the growth of fungi that cause infection.
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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.