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

Letters3 November 2020Rivaroxaban Plasma Levels and LevetiracetamFrancesco Paciullo, MD, Cinzia Costa, PhD, and Paolo Gresele, MD, PhDFrancesco Paciullo, MDUniversity of Perugia, Perugia, Italy (F.P., C.C., P.G.)Search for more papers by this author, Cinzia Costa, PhDUniversity of Perugia, Perugia, Italy (F.P., C.C., P.G.)Search for more papers by this author, and Paolo Gresele, MD, PhDUniversity of Perugia, Perugia, Italy (F.P., C.C., P.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1066 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We fully agree with Brouwer and colleagues' position. Substantial modifications of direct oral anticoagulant (DOAC) levels by antiviral agents that interfere with P-glycoprotein, CYP3A4, or both have recently been confirmed in patients with COVID-19. In addition, several expert position statements recommend measuring DOAC plasma levels in these patients. We thus agree that DOACs should be used at a fixed dose for most patients but that plasma levels should be measured in some patients.We thank Dr. Hellfritzsch and associates for their thoughts on the lack of evidence of a clinically relevant drug–drug interaction between levetiracetam and rivaroxaban in ...References1. 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] doi:10.3390/molecules22101484 CrossrefMedlineGoogle Scholar2. Levy RH, Ragueneau-Majlessi I, Baltes E. Repeated administration of the novel antiepileptic agent levetiracetam does not alter digoxin pharmacokinetics and pharmacodynamics in healthy volunteers. Epilepsy Res. 2001;46:93-9. [PMID: 11463510] CrossrefMedlineGoogle Scholar3. Hughes J, Crowe A. Inhibition of P-glycoprotein-mediated efflux of digoxin and its metabolites by macrolide antibiotics. J Pharmacol Sci. 2010;113:315-24. [PMID: 20724802] CrossrefMedlineGoogle Scholar4. Gnoth MJ, Buetehorn U, Muenster U, et al. In vitro and in vivo P-glycoprotein transport characteristics of rivaroxaban. J Pharmacol Exp Ther. 2011;338:372-80. [PMID: 21515813] CrossrefMedlineGoogle Scholar5. Yang HW, Liu HY, Liu X, et al. Increased P-glycoprotein function and level after long-term exposure of four antiepileptic drugs to rat brain microvascular endothelial cells in vitro. Neurosci Lett. 2008;434:299-303. [PMID: 18313849] 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. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRivaroxaban Plasma Levels and Levetiracetam: A Case Report 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 Rivaroxaban Plasma Levels and Levetiracetam Vineet Punia Rivaroxaban Plasma Levels and Levetiracetam Maja Hellfritzsch , Jakob Christensen , and Lars Peter Nielsen Metrics 3 November 2020Volume 173, Issue 9Page: 772KeywordsBlood plasmaConflicts of interestDisclosureDrug interactionsDrugsElectroencephalographyEpilepsyEpileptic seizuresFrontal lobePlasma cells ePublished: 3 November 2020 Issue Published: 3 November 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...