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We conducted an open\u2010label drug\u2013drug interaction study to determine the pharmacokinetics of apixaban in lung and kidney transplant recipients who were taking a calcineurin inhibitor. A single dose of apixaban 10\u00a0mg was administered orally to kidney and lung transplant recipients maintained on either tacrolimus or cyclosporine, and pharmacokinetic parameters were compared to a reference cohort of 12 healthy subjects who used the same apixaban dose and pharmacokinetic blood sampling. Fourteen participants were enrolled (<jats:italic>n<\/jats:italic>\u00a0=\u00a06 kidney, <jats:italic>n<\/jats:italic>\u00a0=\u00a08 lung), with 10 maintained on tacrolimus and four on cyclosporine. Data from 13 participants was usable. Participants were taking triple therapy immunosuppression and had a mean (SD) of 12 (3) medications. Participants receiving tacrolimus and cyclosporine had area under the plasma concentration\u2013time curve from time zero to infinity (AUC<jats:sub>0\u2010inf<\/jats:sub>) geometric least square means (90% confidence interval [CI]) of 4312 (95% CI 3682, 5049) and 5388 (95% CI 3277, 8858), respectively. Compared to healthy subjects, the associated geometric mean ratios (GMRs) for apixaban maximum plasma concentration (C<jats:sub>max<\/jats:sub>), AUC from time zero to the last quantifiable concentration (AUC<jats:sub>0\u2010tlast<\/jats:sub>) and AUC<jats:sub>0\u2010inf<\/jats:sub> were 197% (95% CI 153, 295), 244% (95% CI 184, 323), and 224% (95% CI 170, 295) for transplant recipients on tacrolimus. The GMR (90% CI) C<jats:sub>max<\/jats:sub>, AUC<jats:sub>0\u2010tlast<\/jats:sub>, and AUC<jats:sub>0\u2010inf<\/jats:sub> of apixaban for patients on cyclosporine were 256% (95% CI 184, 358), 287% (95% CI 198, 415), and 280% (95% CI 195, 401). Kidney and lung transplant recipients receiving tacrolimus had higher apixaban exposure. A similar trend was noted for patients receiving cyclosporine, but additional patients are needed to confirm this interaction. Future studies are needed before apixaban can be safely recommended in this population, and the impact of dose staggering should be investigated. This study highlights the importance of pharmacokinetic studies in actual patient populations.<\/jats:p>","DOI":"10.1111\/cts.13284","type":"journal-article","created":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T19:17:34Z","timestamp":1650395854000},"page":"1687-1697","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pharmacokinetics of apixaban and tacrolimus or cyclosporine in kidney and lung transplant recipients"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6405-4775","authenticated-orcid":false,"given":"Holly","family":"Mansell","sequence":"first","affiliation":[{"name":"College of Pharmacy and Nutrition University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Shoker","sequence":"additional","affiliation":[{"name":"Divison of Medicine, Department of Medicine University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Alcorn","sequence":"additional","affiliation":[{"name":"College of Pharmacy and Nutrition University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Fenton","sequence":"additional","affiliation":[{"name":"Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian S.","family":"Tam","sequence":"additional","affiliation":[{"name":"Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Semchuk","sequence":"additional","affiliation":[{"name":"Pharmacy Services 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