OBJECT DRUGS

Anticoagulants, Oral:

• Apixaban (Eliquis)
• Rivaroxaban (Xarelto)

PRECIPITANT DRUGS

Enzyme Inducers:

• Barbiturates
• Bosentan (Tracleer)
• Carbamazepine (Tegretol, etc.)
• Dabrafenib (Tafinlar)
• Efavirenz (Sustiva)
• Lumacaftor (Orkambi)
• Etravirine (Intelence)
• Nevirapine (Viramune, etc.)
• Oxcarbazepine (Trileptal, etc.)
• Phenytoin (Dilantin, etc.)
• Primidone (Mysoline)
• Rifabutin (Mycobutin)
• Rifampin (Rifadin, etc.)
• Rifapentine (Priftin)
• St. John's Wort

Comment:

Inducers of CYP3A4 may reduce the concentration of apixaban and rivaroxaban. Several days to weeks may be required to see the full effect an inducer on apixaban or rivaroxaban. Since apixaban and rivaroxaban are also substrates for P-glycoprotein, precipitant drugs that induce both CYP3A4 and P-glycoprotein may produce a larger decrease in anticoagulant concentrations. A reduction in the anticoagulant effect may occur.

Class 3: Assess Risk & Take Action if Necessary

• Monitor: Monitor for altered anticoagulant effect if a CYP3A4 or P-glycoprotein inducer is initiated, discontinued or changed in dosage; adjustments of anticoagulant dosage may be needed.