%0 Journal Article
%T Apixaban Concentration with and without Coadministration of Carbamazepine: A Case with No Apparent Interaction
%A Artur Szkotak
%A Linda Stang
%A Norelle Evanger
%A Tammy J Bungard
%J Archive of "The Canadian Journal of Hospital Pharmacy".
%D 2017
%X The direct-acting oral anticoagulants (DOACs) have many advantages over warfarin. In particular, apixaban has rapid onset (1¨C3 h) and offset (half-life 8¨C15 h) of action, with predictable dosing, which precludes the need for routine coagulation monitoring.1 In contrast to warfarin, which has numerous drug¨Cdrug interactions, apixaban has fewer reported drug¨Cdrug interactions.2,3 Apixaban is primarily metabolized by the cytochrome P450 isozymes CYP3A4 and CYP3A5 and is a substrate for the P-glycoprotein (P-gp) transport protein.4 Drugs that are strong inhibitors or inducers of both CYP3A4 and P-gp are reported to increase and decrease apixaban concentrations, respectively. The manufacturer¡¯s product monograph states that strong inhibitors of both these pathways are contraindicated in combination with apixaban, whereas those that are strong inducers (such as carbamazepine) should ¡°generally be avoided¡± given the likelihood of reduced apixaban concentrations4; however, there are no specific data describing this interaction.
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737190/