eliquis and depakote interaction

[michaelrack]

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I work with some geriatric inpatients, as a psychiatrist. Some of them come in on a combination of Eliquis and depakote (the depakote is typically for mood lability, but sometimes it was prescribed for seizures).
Our EMR gives a warning about using these 2 meds together.

according to a quick copilot search:

Evidence shows two main concerns when Depakote and Eliquis are taken together:

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• Valproic acid/Depakote can decrease apixaban plasma levels, likely through P‑glycoprotein induction and possibly CYP3A4 induction.
• This may lead to subtherapeutic anticoagulation and increased risk of stroke or systemic embolism.
• A large nested case‑control study found higher stroke/systemic embolism risk when DOACs (including apixaban) were used with valproic acid.

How serious is this interaction, in your experience?

 

[s5260205]

I do not prescribe Depakote and apixaban together. There are other options for both mood lability and seizures that do not interact with apixaban. I am biased being a neurologist, though the number of large vessel occlusion I've seen from apixaban being withheld for minor, non-emergent procedures really deter me from messing around with those on apixaban for AF.