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DOAC renal review — GPhC CRA MCQ

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HardCardiovascular TherapeuticsDOAC renal reviewGPhC CRA

A patient taking apixaban for atrial fibrillation receives oral ketoconazole for a systemic fungal infection. What should the pharmacist do?

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Correct answer: B — Query ketoconazole; strong inhibition can raise apixaban exposure

Systemic ketoconazole strongly inhibits CYP3A4 and P-glycoprotein and can increase apixaban exposure and bleeding. The combination requires prescriber review and may need avoidance or an alternative strategy; dose separation and INR testing do not manage this interaction.

Reference: BNF: apixaban: https://bnf.nice.org.uk/drugs/apixaban/