The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching Points
Concomitant use of apixaban and carbamazepine (CBZ) is not recommended due to an anticipated reduction in apixaban concentration, although few case reports describe this interaction. We report a case of initiating apixaban 10 mg twice daily (BID), in a patient stabilized on CBZ 600 mg BID that was g...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-04-01
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| Series: | CJC Open |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589790X22000026 |
| _version_ | 1817987361189920768 |
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| author | Ayush Chadha David Lopaschuk, BSc, BSc(Pharm), PharmD Margaret L. Ackman, BSc(Pharm), PharmD Tammy J. Bungard, BSP, PharmD |
| author_facet | Ayush Chadha David Lopaschuk, BSc, BSc(Pharm), PharmD Margaret L. Ackman, BSc(Pharm), PharmD Tammy J. Bungard, BSP, PharmD |
| author_sort | Ayush Chadha |
| collection | DOAJ |
| description | Concomitant use of apixaban and carbamazepine (CBZ) is not recommended due to an anticipated reduction in apixaban concentration, although few case reports describe this interaction. We report a case of initiating apixaban 10 mg twice daily (BID), in a patient stabilized on CBZ 600 mg BID that was guided by prior experience. Apixaban concentrations were substantially elevated with initial empiric dosing; apixaban dosing of 7.5 mg BID was eventually implemented. This case highlights the fact that the degree of induction by CBZ can vary, regardless of the dose, and requires clinicians to be cautious when applying prior experiences with patients to new patients. Résumé: L’utilisation concomitante de l’apixaban et de la carbamazépine (CBZ) n’est pas recommandée puisqu’on l’attribue à la réduction anticipée des concentrations de l’apixaban, bien que peu d’observations décrivent cette interaction. Nous présentons un cas sur l’amorce de l’apixaban (10 mg deux fois par jour [BID]) chez un patient stabilisé par CBZ, 600 mg BID (en fonction d’expériences antérieures). La posologie empirique initiale a fait substantiellement augmenter les concentrations d’apixaban; la posologie de l’apixaban de 7,5 mg BID a finalement été mise en place. Ce cas illustre le fait que le degré d’induction par CBZ peut varier, indépendamment de la dose, et obliger les cli-niciens à être prudents lorsqu’ils transposent leurs expériences antérieures aux nouveaux patients. |
| first_indexed | 2024-04-14T00:20:51Z |
| format | Article |
| id | doaj.art-746567d2a5e647e3a6170a3627ed20ed |
| institution | Directory Open Access Journal |
| issn | 2589-790X |
| language | English |
| last_indexed | 2024-04-14T00:20:51Z |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | CJC Open |
| spelling | doaj.art-746567d2a5e647e3a6170a3627ed20ed2022-12-22T02:22:58ZengElsevierCJC Open2589-790X2022-04-0144435438The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching PointsAyush Chadha0David Lopaschuk, BSc, BSc(Pharm), PharmD1Margaret L. Ackman, BSc(Pharm), PharmD2Tammy J. Bungard, BSP, PharmD3Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, CanadaPharmacy Services, Alberta Health Services, Edmonton, Alberta, CanadaPharmacy Services, Alberta Health Services, Edmonton, Alberta, CanadaDivision of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Corresponding author: Dr Tammy J. Bungard, 8425 Aberhart Centre, 11402 University Ave., University of Alberta, Edmonton, Alberta T6G 2J3, Canada. Tel.: +1-780-407-8597; fax: +1-780-407-8907.Concomitant use of apixaban and carbamazepine (CBZ) is not recommended due to an anticipated reduction in apixaban concentration, although few case reports describe this interaction. We report a case of initiating apixaban 10 mg twice daily (BID), in a patient stabilized on CBZ 600 mg BID that was guided by prior experience. Apixaban concentrations were substantially elevated with initial empiric dosing; apixaban dosing of 7.5 mg BID was eventually implemented. This case highlights the fact that the degree of induction by CBZ can vary, regardless of the dose, and requires clinicians to be cautious when applying prior experiences with patients to new patients. Résumé: L’utilisation concomitante de l’apixaban et de la carbamazépine (CBZ) n’est pas recommandée puisqu’on l’attribue à la réduction anticipée des concentrations de l’apixaban, bien que peu d’observations décrivent cette interaction. Nous présentons un cas sur l’amorce de l’apixaban (10 mg deux fois par jour [BID]) chez un patient stabilisé par CBZ, 600 mg BID (en fonction d’expériences antérieures). La posologie empirique initiale a fait substantiellement augmenter les concentrations d’apixaban; la posologie de l’apixaban de 7,5 mg BID a finalement été mise en place. Ce cas illustre le fait que le degré d’induction par CBZ peut varier, indépendamment de la dose, et obliger les cli-niciens à être prudents lorsqu’ils transposent leurs expériences antérieures aux nouveaux patients.http://www.sciencedirect.com/science/article/pii/S2589790X22000026 |
| spellingShingle | Ayush Chadha David Lopaschuk, BSc, BSc(Pharm), PharmD Margaret L. Ackman, BSc(Pharm), PharmD Tammy J. Bungard, BSP, PharmD The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching Points CJC Open |
| title | The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching Points |
| title_full | The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching Points |
| title_fullStr | The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching Points |
| title_full_unstemmed | The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching Points |
| title_short | The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With CarbamazepineNovel Teaching Points |
| title_sort | problem with predictions a cautionary tale of empirically adjusting apixaban dosing with carbamazepinenovel teaching points |
| url | http://www.sciencedirect.com/science/article/pii/S2589790X22000026 |
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