One common adverse reaction of apixaban that can be confused with an acute porphyric attack is nausea. This side effect may potentially be porphyrinogenic if leading to a decrease in carbohydrate intake.

Apixiban is not reported to be an inducer or a mechanism-based inhibitor of CYP enzymes, and is not observed to alter the metabolism of other CYP metabolized drugs. No pharmacokinetic porphyrinogenic effects are suspected.

Phenylpiperidines

Apixaban is an antithrombotic agent, a direct inhibitor of factor Xa, used in the prevention and treatment of thromboembolic diseases. It is administered orally.

Cmax of apixiban is reported to be 80.5 ng/mL (Frost 2014). This is equivalent to 175 nM and hepatic exposure is therefore significant.

Apixaban mainly undergoes O-demethylation and hydroxylation to its metabolites. It is metabolized mainly via CYP3A4/5 with minor contributions from CYP1A2, 2C8, 2C9, 2C19, and 2J2 (SPC). Apixaban is neither an inducer of CYP1A2, 2B6 or 3A4/5, nor an inhibitor of CYP1A2, 2A6, 2B6, 2C8, 2C9, 2D6 or 3A4 in vitro. It has been reported to be a weak inhibitor of CYP2C19 in vitro, but this was at concentrations significantly higher than peak plasma concentrations (SPC). Apixaban is not observed to alter the metabolism of other CYP metabolized drugs (interaksjonsdatabasen.dk, SPC).