Drug interactions
Apixaban + Mitotane
Severity: Major
Apixaban and Mitotane: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Mitotane is a strong CYP3A4 inducer and can substantially lower apixaban concentrations, risking thrombosis or stroke from inadequate anticoagulation. The inducing effect persists for weeks after mitotane is stopped.
What this interaction means in plain words
Apixaban and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Apixaban belongs to Cardiovascular; Mitotane belongs to Oncology.
Why it happens
Induction of CYP3A4 (and likely P-gp) increases apixaban clearance.
What to do
Avoid the combination and choose an alternative anticoagulant such as low-molecular-weight heparin or a vitamin K antagonist with INR monitoring.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Apixaban
- Apixaban + Dabigatran Contraindicated
- Apixaban + Defibrotide Contraindicated
- Apixaban + Edoxaban Contraindicated
- Apixaban + Ketorolac Contraindicated
- Apixaban + Mifepristone Contraindicated
- Abciximab + Apixaban Major
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Aprepitant + Mitotane Major
- Aripiprazole + Mitotane Major
Frequently asked questions
Can I take Apixaban with Mitotane?
MediHelp rates the interaction as major. Apixaban and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Mitotane is a strong CYP3A4 inducer and can substantially lower apixaban concentrations, risking thrombosis or stroke from inadequate anticoagulation. The inducing effect persists for weeks after mitotane is stopped.
How serious is the interaction between Apixaban and Mitotane?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and choose an alternative anticoagulant such as low-molecular-weight heparin or a vitamin K antagonist with INR monitoring.
What other medicines interact with Apixaban?
MediHelp also lists interactions of Apixaban with, for example, Dabigatran, Defibrotide, Edoxaban. The full list is on the Apixaban page.
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