From the Research
Topiramate can be used as a mood stabilizer in patients taking Eliquis (apixaban), but careful monitoring is recommended. There are no significant direct drug interactions between topiramate and Eliquis that would prevent their concurrent use 1. Topiramate is typically started at a low dose of 25-50mg daily and gradually increased to an effective dose, often 100-200mg daily divided into two doses. When adding topiramate to a regimen that includes Eliquis, it's essential to monitor for any changes in bleeding risk or anticoagulation effect, though this specific interaction is not commonly reported.
Key Considerations
- Topiramate works as a mood stabilizer by enhancing GABA activity and blocking glutamate receptors in the brain, which helps regulate neuronal excitability.
- Patients should be aware that topiramate may cause side effects including cognitive slowing, word-finding difficulties, paresthesias, and kidney stones.
- Regular follow-up appointments are necessary to assess both mood stabilization efficacy and to ensure the anticoagulation therapy remains effective and safe.
- The effects of apixaban on coagulation assays are notable, with an increase in INR in hospitalized patients, although the clinical impact is not clear 2.
- A chromogenic anti-FXa assay can be used for reliable measurements of apixaban concentration 3.
Monitoring and Safety
- Monitoring for changes in bleeding risk or anticoagulation effect is crucial when using topiramate and Eliquis concurrently.
- The use of APTT and/or PT assays to screen the anticoagulant activity of apixaban is not recommended 3.
- Apixaban has a good safety profile, with a low risk of bleeding events, as shown in multiple randomized controlled trials, including ARISTOTLE and AMPLIFY 1.