MajorDirect oral anticoagulants (factor Xa inhibitors)×Antiepileptics. Carboxamide derivatives
Updated · Methodology
Mechanism
Carbamazepine is a strong inducer of CYP3A4 and P-glycoprotein. Apixaban exposure falls by about half (by 54% with rifampicin), weakening protection against stroke in atrial fibrillation and against recurrent venous thromboembolism. The FDA recommends avoiding the combination.
Symptoms
No overdose symptoms – the danger is undertreatment: ischemic stroke, recurrent DVT or PE despite ongoing anticoagulant.
Management
Avoid the combination. The AEMPS label splits by indication: apixaban is not used with carbamazepine to treat deep vein thrombosis or pulmonary embolism, and is used with caution in atrial fibrillation and to prevent recurrent thrombosis. Alternative anticoagulant when carbamazepine is needed: warfarin, whose effect is tracked by INR, so the induction can be offset by dose. Alternative anticonvulsant: levetiracetam or lacosamide, neither induces CYP3A4.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Eliquis (apixaban) prescribing information (2021)– ; DailyMed setid e9481622-7cc6-418a-acb6-c5450daae9b0
- AEMPS: Ficha técnica: Apixabán (nº registro 111691009), sección 4.4 (2026)– AEMPS, CIMA, nº registro 111691009, sección 4.4, texto de la EMA publicado en CIMA, consultado en septiembre de 2026
- AEMPS: Ficha técnica: Carbamazepina (nº registro 62621), sección 4.5 (2025)– AEMPS, CIMA, nº registro 62621, sección 4.5
- FDA: Eliquis (apixaban) tablets – Prescribing Information (2026)– FDA, DailyMed SPL, Cardinal Health 107, раздел 7.2, пересмотр этикетки 04/2026