Drug interactions
Apixaban + Primidone
Severity: Major
Apixaban and Primidone: major interaction.
Last updated Sources: UK SmPC
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
Primidone is partly converted to phenobarbital and so acts as an enzyme inducer. It is expected to lower apixaban concentrations and weaken anticoagulation. This could result in stroke or thromboembolism.
What this interaction means in plain words
Apixaban and Primidone 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; Primidone belongs to Central Nervous System.
Why it happens
Primidone and its metabolite phenobarbital induce CYP3A4 and P-glycoprotein, increasing apixaban clearance.
What to do
Avoid the combination and choose a non-inducing anticonvulsant where possible. If both are needed, consider warfarin with INR monitoring instead of apixaban.
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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References
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 Primidone
- Lorlatinib + Primidone Contraindicated
- Lurasidone + Primidone Contraindicated
- Primidone + Ranolazine Contraindicated
- Primidone + Sofosbuvir-velpatasvir-voxilaprevir Contraindicated
- Primidone + Voriconazole Contraindicated
- Abiraterone + Primidone Major
Frequently asked questions
Can I take Apixaban with Primidone?
MediHelp rates the interaction as major. Apixaban and Primidone 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. Primidone is partly converted to phenobarbital and so acts as an enzyme inducer. It is expected to lower apixaban concentrations and weaken anticoagulation. This could result in stroke or thromboembolism.
How serious is the interaction between Apixaban and Primidone?
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 a non-inducing anticonvulsant where possible. If both are needed, consider warfarin with INR monitoring instead of apixaban.
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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