Rivaroxaban Plasma Levels and Levetiracetam: A Case Report
Authors: Francesco Paciullo, Cinzia Costa, Paolo Gresele
Journal: Annals of Internal Medicine (2020)

Letters7 July 2020Rivaroxaban Plasma Levels and Levetiracetam: A Case ReportFrancesco Paciullo, MD, Cinzia Costa, PhD, and Paolo Gresele, MD, PhDFrancesco Paciullo, MDUniversity of Perugia, Perugia, Italy (F.P., C.C., P.G.), Cinzia Costa, PhDUniversity of Perugia, Perugia, Italy (F.P., C.C., P.G.), and Paolo Gresele, MD, PhDUniversity of Perugia, Perugia, Italy (F.P., C.C., P.G.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0712 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Recent guidelines from the American Society of Hematology suggest that clinicians avoid prescribing P-glycoprotein inducers or inhibitors for patients who are taking rivaroxaban (1). The reason is that P-glycoprotein critically regulates the absorption, distribution, and secretion of anti-Xa direct oral anticoagulants like rivaroxaban (2). Animal studies suggest that levetiracetam, a commonly used medication to prevent seizures, acts as a P-glycoprotein inducer to reduce rivaroxaban plasma levels (2, 3). However, not everyone is convinced that levetiracetam should be avoided in patients receiving rivaroxaban because there is little or no published evidence describing this interaction in humans (4).Objective: To present ...References1. Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv. 2018;2:3257-91. [PMID: 30482765] doi:10.1182/bloodadvances.2018024893 CrossrefMedlineGoogle Scholar2. Galgani A, Palleria C, Iannone LF, et al. Pharmacokinetic interactions of clinical interest between direct oral anticoagulants and antiepileptic drugs. Front Neurol. 2018;9:1067. [PMID: 30581412] doi:10.3389/fneur.2018.01067 CrossrefMedlineGoogle Scholar3. Moerman L, Wyffels L, Slaets D, et al. Antiepileptic drugs modulate P-glycoproteins in the brain: a mice study with (11)C-desmethylloperamide. Epilepsy Res. 2011;94:18-25. [PMID: 21277169] doi:10.1016/j.eplepsyres.2010.12.013 CrossrefMedlineGoogle Scholar4. Mathy FX, Dohin E, Bonfitto F, et al. Drug-drug interaction between levetiracetam and non-vitamin K antagonist anticoagulants. Eur Heart J. 2019;40:1571. [PMID: 30500876] doi:10.1093/eurheartj/ehy780 CrossrefMedlineGoogle Scholar5. European Medicines Agency. Summary of product characteristics. Accessed at www.ema.europa.eu/en/documents/product-information/xarelto-epar-product-information_en.pdf on 28 January 2020. Google Scholar6. Testa S, Paoletti O, Legnani C, et al. Low drug levels and thrombotic complications in high-risk atrial fibrillation patients treated with direct oral anticoagulants. J Thromb Haemost. 2018;16:842-8. [PMID: 29532628] doi:10.1111/jth.14001 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Perugia, Perugia, Italy (F.P., C.C., P.G.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0712.Correction: This article was corrected on 15 May 2020 to clarify language about the clinical presentation of the patient in the third sentence of the "Case Report" section. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRivaroxaban Plasma Levels and Levetiracetam Marc A. Brouwer , Stijn P.G. van Vugt , Jeroen Jaspers Focks , Sander A.J. Damen , and Freek W.A. Verheugt Rivaroxaban Plasma Levels and Levetiracetam Vineet Punia Rivaroxaban Plasma Levels and Levetiracetam Francesco Paciullo , Cinzia Costa , and Paolo Gresele Rivaroxaban Plasma Levels and Levetiracetam Maja Hellfritzsch , Jakob Christensen , and Lars Peter Nielsen Metrics Cited byDrug-drug interactions with direct oral anticoagulants for the prevention of ischemic stroke and embolism in atrial fibrillation: a narrative review of adverse eventsInteractions Between Direct Oral Anticoagulants (DOACs) and Antiseizure Medications: Potential Implications on DOAC TreatmentRelevant pharmacologic interactions in the concurrent management of brain tumor-related epilepsy and venous thromboembolism: a systematic reviewCardiovascular DrugsConcomitant Use of Direct Oral Anticoagulants and Antiepileptic Drugs: A Prospective Cohort Study in Patients with Atrial FibrillationAnti-epileptic medicationsA neurological point of view on the European Society of Cardiology guidelines: the interactions between direct oral anticoagulants and antiepileptic drugsRivaroxaban Plasma Levels and LevetiracetamMarc A. Brouwer, MD, PhD, Stijn P.G. van Vugt, MD, Jeroen Jaspers Focks, MD, PhD, Sander A.J. Damen, MD, and Freek W.A. Verheugt, MD, PhDRivaroxaban Plasma Levels and LevetiracetamMaja Hellfritzsch, MD, PhD, Jakob Christensen, PhD, DrMedSci, and Lars Peter Nielsen, MDRivaroxaban Plasma Levels and LevetiracetamVineet Punia, MD, MSLevetiracetam/rivaroxaban interaction 7 July 2020Volume 173, Issue 1Page: 71-72KeywordsBlood plasmaDrug administrationDrugsEpileptic seizuresHematology and oncologyParalysisPlateletsResearch laboratoriesThrombocytosisTransient ischemic attacks ePublished: 14 April 2020 Issue Published: 7 July 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...