Rivaroxaban Plasma Levels and Levetiracetam
Authors: Maja Hellfritzsch, Jakob Christensen, Lars Peter Nielsen
Journal: Annals of Internal Medicine (2020)

Letters3 November 2020Rivaroxaban Plasma Levels and LevetiracetamMaja Hellfritzsch, MD, PhD, Jakob Christensen, PhD, DrMedSci, and Lars Peter Nielsen, MDMaja Hellfritzsch, MD, PhDAarhus University Hospital, Aarhus, Denmark (M.H., J.C., L.P.N.)Search for more papers by this author, Jakob Christensen, PhD, DrMedSciAarhus University Hospital, Aarhus, Denmark (M.H., J.C., L.P.N.)Search for more papers by this author, and Lars Peter Nielsen, MDAarhus University Hospital, Aarhus, Denmark (M.H., J.C., L.P.N.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1064 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Paciullo and colleagues' case report (1) describing an incident of treatment failure of rivaroxaban during concomitant use of levetiracetam with interest. Because rivaroxaban levels were subtherapeutic despite treatment adherence, the authors suspected a clinically relevant drug–drug interaction with levetiracetam. The assumed mechanism is induction of P-glycoprotein, leading to decreased absorption and increased excretion of rivaroxaban.P-glycoprotein and CYP3A4 are important to the pharmacokinetics of rivaroxaban, and enzyme induction may lead to subtherapeutic rivaroxaban levels. This has been shown for rifampicin, a potent inducer of P-glycoprotein and CYP3A4 (2). Thus, when the potential for drug–drug interaction ...References1. Paciullo F, Costa C, Gresele P. Rivaroxaban plasma levels and levetiracetam: a case report [Letter]. Ann Intern Med. 2020;173:71-2 LinkGoogle Scholar2. Foerster KI, Hermann S, Mikus G, et al. Drug-drug interactions with direct oral anticoagulants. Clin Pharmacokinet. 2020;59:967-80. [PMID: 32157630] CrossrefMedlineGoogle Scholar3. Moerman L, Wyffels L, Slaets D, et al. Antiepileptic drugs modulate P-glycoproteins in the brain: a mice study with 11C-desmethylloperamide. Epilepsy Res. 2011;94:18-25. [PMID: 21277169] CrossrefMedlineGoogle Scholar4. Grewal GK, Kukal S, Kanojia N, et al. In vitro assessment of the effect of antiepileptic drugs on expression and function of ABC transporters and their interactions with ABCC2. Molecules. 2017;22. [PMID: 28961159] CrossrefMedlineGoogle Scholar5. Benedetti MS. Enzyme induction and inhibition by new antiepileptic drugs: a review of human studies. Fundam Clin Pharmacol. 2000;14:301-19. [PMID: 11030437] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Aarhus University Hospital, Aarhus, Denmark (M.H., J.C., L.P.N.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1064. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRivaroxaban Plasma Levels and Levetiracetam: A Case Report Francesco Paciullo , Cinzia Costa , and Paolo Gresele Rivaroxaban Plasma Levels and Levetiracetam Vineet Punia Rivaroxaban Plasma Levels and Levetiracetam Francesco Paciullo , Cinzia Costa , and Paolo Gresele Rivaroxaban Plasma Levels and Levetiracetam Marc A. Brouwer , Stijn P.G. van Vugt , Jeroen Jaspers Focks , Sander A.J. Damen , and Freek W.A. Verheugt Metrics 3 November 2020Volume 173, Issue 9Page: 771KeywordsBlood plasmaDisclosureDrug interactionsDrugsEnzymesExcretionPharmacokineticsRisk managementStrokeTreatment guidelines ePublished: 3 November 2020 Issue Published: 3 November 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...