Major
Established
Descripción
Cyclosporine significantly increases apixaban exposure through inhibition of CYP3A4 and P-glycoprotein, elevating bleeding risk.
Mecanismo
Apixaban is metabolised by CYP3A4 and transported by P-gp; cyclosporine inhibits both pathways, substantially increasing apixaban AUC and Cmax.
Relevancia clínica
FDA labeling recommends dose reduction of apixaban when combined with strong dual inhibitors; bleeding risk increases proportionally to AUC.
Manejo clínico
Reduce apixaban to 2.5 mg BID when strong dual CYP3A4/P-gp inhibitors such as cyclosporine are used; monitor closely for bleeding.