Possible drug interactions with Xtandi and blood thinners - advice needed

[Lynsi13]

Hello!

I have a question about drug interactions with Xtandi. When my dad first had his heart bypass, his Cleveland clinic doctor's put him on Eliquis along with his xtandi.

Shortly after, dad was diagnosed at the James cancer center with a secondary cancer - lymphoma in his brain. The doctors at the James explained that there was a potential for Xtandi to make eliquis less effective and put dad on Savaysa.

Well now Medicare has decided to pull Savaysa from their formulary and it is going to cost dad $1100/month... More than he can afford.

Dad's oncologist said Coumadin would be an option, but dad is also on plavix and that would create another drug interaction. Not to mention Coumadin is difficult to manage, especially so with Xtandi (according to the doctor).

I have spoken with men who have taken eliquis and xtandi together without issue. I don't know if it will come down to this but if a decision must be made regarding taking the risk for a potentially less effective blood thinner and paying $1,100 out of pocket a month, I imagine my dad would have to choose the less effective medicine option.

If anyone has any advice, I'd really appreciate it!

Thanks so much,

Lynsi

[Heilung18-Gesund]

Lynsi,

Does your father still need fill DOAC anticoagulation? With CNS lymphoma, one might be concerned about any intracerebral bleed.

At any rate, enzalutamide does interfere with apixaban efficacy. An alternative to edoxaban would be dabigratran; however, I would make sure full anti-platelet plus thrombin-antagonist anticoagulation are still indicated. Risks of hemorrhage are certainly higher, especially for higher age brackets.

All the best,

TB

[tango65]

The information is correct, eliquis and xtandi interact and the efficacy of eliquis is decreased:

reference.medscape.com/drug...

He could be treated with dabigatran which does not interact with enzalutamide.

[leebeth]

My brother was on Eliquis along with Xtandi, and yes, there is a small decrease in efficacy of the Eliquis. He was really on it for prophylaxis of recurrent DVT, so he just took 5 mg to make sure he was covered.

If he had been on it for afib, I would have wanted him to change from Xtandi to darolutamide, to be honest. Eliquis is the best of the anticoagulants, and there is no way I would have wanted him on warfarin.

Best of luck to you as you navigate this!

[lcfcpolo]

HiI have been on Xtandi (Enzalutamide) and Eliquis (Apixaban) for over two and a half years now. I'm on 4 Xtandi tablets, 160mg in total nightly. I take one 5mg Eliquis tablet in the morning and one 5mg Eliquis tablet in the evening. I was prescribed the Eliquis due to recurring DVTs (Deep Vein Thrombosis) in my legs. I was monitored closely to start and they found that the Eliquis was working fine. Good luck.

[MandMP13]

Hi,

My father is also on Eliquis for AFib. When he needed to start ADT treatment the hospital Specialty pharmacy researched all the major drug interactions. He was advised not to take Xtandi and his MO started him on Zytiga instead. This could be a possible option for your dad.

Hope this helps and wishing you the best!