DOAC + strong CYP3A/P-gp inducer — ↓ anticoagulation
- Strong induction ↓ DOAC exposure
- rifampin lowers apixaban AUC ~54%
- dabigatran exposure ↓ ~65–70%
- Thrombosis/stroke risk rises
- Avoid rifampin/CBZ/PHT/phenobarbital
- Consider warfarin if induction unavoidable
Interaction at a glance
- Strong induction ↓ DOAC exposure
- rifampin lowers apixaban AUC ~54%
- dabigatran exposure ↓ ~65–70%
- Avoid rifampin/CBZ/PHT/phenobarbital
Magnitude / time course
- Strong induction ↓ DOAC exposure
- rifampin lowers apixaban AUC ~54%
- dabigatran exposure ↓ ~65–70%
Clinical consequence
- Thrombosis/stroke risk rises
Management
- Avoid rifampin/CBZ/PHT/phenobarbital
- Consider warfarin if induction unavoidable
Self-check
- In DOAC + strong CYP3A/P-gp inducer, what is the approximate magnitude of the exposure change?
rifampin lowers apixaban AUC ~54%
- What is the preferred management of DOAC + strong CYP3A/P-gp inducer?
Avoid rifampin/CBZ/PHT/phenobarbital.
Drugs in this interaction (12)
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