Amiodarone × Apixaban

Amiodarone moderately blocks P-glycoprotein and CYP3A4 – two apixaban clearance routes. Apixaban plasma levels rise by about 50%, with a modest bleeding risk increase.

Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.

The combination is acceptable without dose change in patients with atrial fibrillation. In elderly patients weighing ≤60 kg or with serum creatinine ≥133 µmol/L, reduce apixaban to 2.5 mg twice daily. PPI cover with pantoprazole is advisable.