Drug Interaction Report

GENERALLY AVOID: Coadministration with potent inducers of CYP450 3A4 that also induce P-glycoprotein (P-gp) may significantly decrease the plasma concentrations of apixaban, which is a substrate of both the isoenzyme and the efflux transporter. When apixaban was coadministered with 600 mg/day of rifampin, a dual P-gp and potent CYP450 3A4 inducer, mean apixaban peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 42% and 54%, respectively. Reduced efficacy, increased stroke rates, and paradoxically, an increased risk of bleeding have been reported in a clinical study in patients with atrial fibrillation taking apixaban with concomitant dual P-gp and potent CYP450 3A4 inducers compared with apixaban alone.

MANAGEMENT: Concomitant use of apixaban with dual P-gp and potent CYP450 3A4 inducers should generally be avoided, since efficacy of apixaban may be compromised.