Carbamazepine With Eliquis Concerns And Alternatives

Answer

Great question! Let's break it up into chunks. I'll first go over why your hematologist is cautioning against using Eliquis and carbamazepine together and then we'll get into what your options are.

Eliquis-Carbamazepine Interaction Details

The interaction between Eliquis and carbamazepine is a serious one, and most medical resources recommend avoiding the combination altogether.

Carbamazepine is a strong inducer of the CYP3A4 and P-glycoprotein enzymes. These enzymes play a crucial role in metabolizing and transporting drugs in the body. When carbamazepine is taken, it increases the activity of these enzymes, which can lead to a decrease in the serum concentration of Eliquis. This can make Eliquis less effective, putting you at risk of negative outcomes.

There have been a number of studies that have reported individuals taking carbamazepine and Eliquis together are more at risk for stroke and embolism when compared to individuals not taking carbamazepine (and drugs like it). One such study reported the following:

Higher risk for stroke/SE [systemic emboli] in patients with AF [atrial fibrillation] is associated with concurrent prescriptions of DOACs [like Eliquis] with phenytoin, carbamazepine, valproic acid, or levetiracetam.

Other studies have reported similar results, so this is an interaction to take seriously.

Now, it's important to note that carbamazepine also interacts with warfarin as studies show carbamazepine can decrease INR and the effects of vitamin K antagonists (e.g., warfarin). However, one of the positives of warfarin (if you want to look at it that way) is that the dose is very adjustable based on what your INR is. 

So, whereas carbamazepine will essentially just decrease how effective Eliquis is with little room for adjustments, warfarin can and generally will need to be adjusted if carbamazepine is used along with it.

You specifically asked, in my opinion, if you can in any way be on carbamazepine and Eliquis. I would say barring some reason why carbamazepine is the only therapy option for you, you should work with your doctor to find an alternative for the simple fact that studies show strong evidence that Eliquis will not be as effective. 

Alternatives To Carbamazepine

Providing alternatives to carbamazepine is a little tricky because I don't quite know exactly what you are using it for.

You are correct that it is classified as a 'mood stabilizer', but it is used for a wide variety of medical indications. Generally, when carbamazepine is used as a mood stabilizer, it is for the treatment of bipolar disorder (although they are sometimes used for certain anxiety disorders as well). Other 'mood stabilizers' used for bipolar include:

• Oxcarbazepine
• Lithium
• Lamotrigine
• Topiramate
• Valproate
• Quetiapine (not a mood stabilizer but is sometimes used for bipolar and anxiety disorders)

In terms of viable options to talk with your doctor about, I'll leave off lithium as that has some dosing challenges of its own and sometimes requires monitoring of blood lithium levels, something you've indicated you aren't too crazy about doing with warfarin.

Valproate, which is the active ingredient in several drugs, including Depakote does have an interaction with Eliquis, similar to carbamazepine. It is generally considered less clinically significant but does require monitoring regardless.

So, in regard to mood-stabilizing drugs that don't have documented interactions with Eliquis, we have left:

• Oxcarbazepine
• Lamotrigine
• Topiramate
• Quetiapine

These drugs aren't known to be hard on the liver, but it's still important to use them with caution if you have liver damage.

It's also important to note that while all of these drugs can be used, some of them don't have a lot of evidence to support their effectiveness. For example, Oxcarbazepine can be used as a mood stabilizer, but studies haven't shown that it's consistently effective in treating bipolar disorder.

In terms of what the best option for you is, I don't have all the details about your medical situation or history, so it's important to have a discussion with your doctor to determine the best mood-stabilizing drug for you. It's good to know at least that these options are considered safe to use with Eliquis and don't require lab testing.

Now, in your question, you mentioned you have generalized anxiety disorder and suggested Lexapro (escitalopram).

Lexapro is an SSRI, and all of these drugs come with a bleeding risk when combined with other blood-thinning drugs (like warfarin and Eliquis), but this is more something that you should be aware of and to be on the lookout for signs and symptoms of bleeding if you take it with Eliquis. They are often used together.

In fact, SSRIs are generally considered first-line treatment for generalized anxiety disorder because they have been well-studied and are effective for many people so Lexapro is absolutely a potential option for you.

Again, be sure to speak with your doctor about the best therapy options for your medical situation.

Final Words

Thanks so much for reaching out and I hope you found this helpful.