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DOAC and enzyme inducer — GPhC CRA MCQ

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HardDrug InteractionsDOAC and enzyme inducerGPhC CRA

A patient taking carbamazepine 400 mg twice daily is newly prescribed apixaban for atrial fibrillation after a hospital admission. Renal function is normal and CHA2DS2-VASc is 3. What is the most important interaction to flag?

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Correct answer: B — Carbamazepine may reduce apixaban exposure and anticoagulant effect

Carbamazepine is a strong enzyme inducer and can reduce exposure to some DOACs, including apixaban. This may reduce anticoagulant efficacy and increase stroke risk. The prescriber should consider an alternative anticoagulation strategy or specialist advice.

Reference: BNF; SPS