If your paper uses an electronic medical record alost any contraindicated medications would be flagged up and have to be overridden so in all likelyhood they were aware of any issue as and when they prescribed it

OF course that doesn't apply if 2 different physicians prescribed it on two different emr's

Can't speak to the drugs just the software

Edit to add. The pharmacist who dispensed then if they did it at the same time would almost certainly have been 100% aware if there were an issue and raised it.

Can't guarantee that but between software and the dispensing pharmacists there are checks in place........

Usually

This sounds fairly critical. I might visit the pharmacy and get face to face with the pharmacist who is a better resource than the MD (IMO).

CYP3A4 inducers can increase the metablism of rivaroxaban, decreasing AUC and Cmax

It's saying the Primidone (a CYP3A4 inducer) is going to result in significantly lower rivaroxaban levels in your blood, so the effect will be to effectively lower your rivaroxaban dosage.

The "AUC" and "Cmax" refers to rivaroxaban levels in your blood over time (pharmacokinetics). Cmax is the max concentration of drug in your blood after dosage. So if Cmax is lowered, it looks like you have taken a lower dose. AUC is "area under the curve", which is another pharmacokinetic parameter that describes how much drug circulates for how long in your blood.

Definitely talk to a doc about this asap. Don't want to mess around with anti-thrombotics.

The way I read the chart (bottom line), Primidone is classified as a "Strong inducers of CYP3A4" causing a "Significant reduction in rivaroxaban concentration". That sounds to me like it's reducing the effectiveness of the rivaroxaban (Xarelto). The "Suggested Management Guideline" is "AVOID USE".


I have to stay on the Xarelto, but it will suck to be off of Primidone for a year.

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Pharmacist is mail order, unfortunately.

I've been on Primidone for years, without it my hands shake so badly I can't read my own handwriting. I was on Xarelto from Feb to August for a clot in my right leg, off it for 2 months then came down with a clot in my left leg so I'm back on it for a year. The whole time I was on it I had always commented to my wife that on the occasions I cut myself (shaving, or working, etc) I didn't really bleed like I expected to being on a blood thinner.l

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