Major

Apixaban × Rifabutin

Direct oral anticoagulants (factor Xa inhibitors)×Antitubercular, rifamycin derivative

Mechanism

Rifabutin is a moderate CYP3A4 + P-gp inducer (2-3 fold weaker than rifampicin). Apixaban falls 30-40%. Lower risk than with rifampicin but still significant.

Symptoms

Reduced anticoagulation, thrombosis risk.

Management

If possible – warfarin to INR 2.0-3.0.

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.

Open checker

Sources

FDA: Mycobutin (rifabutin) prescribing information (2018)– FDA Mycobutin label

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