Hepatic enzyme induction — GPhC CRA MCQ
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Correct answer: E — Contact the prescriber before supply to select alternative anticoagulation
Carbamazepine strongly induces CYP3A4 and P-glycoprotein and can reduce apixaban exposure by about half. The authorised information does not recommend the combination for acute DVT or PE treatment because efficacy may be compromised. The prescriber or anticoagulation team must select a reliable anticoagulation strategy while maintaining safe seizure treatment; dose separation does not prevent enzyme induction.
Reference: Apixaban Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/100229/smpc