amiodarone × apixaban

Amiodarone inhibits CYP3A4 and P-glycoprotein – apixaban exposure rises by approximately 40–50 %. Bleeding risk increases, especially in older patients with body weight under 60 kg and eGFR below 50 mL/min.

Formal dose reduction is not mandatory but is advised – in the presence of any of the criteria (age ≥ 80, weight ≤ 60 kg, creatinine ≥ 133 µmol/L), use apixaban 2.5 mg twice daily. Strengthen bleeding surveillance and check hemoglobin and creatinine at 2–4 weeks after initiation.