APIXABAN Drug Interactions
Also known as: ELIQUIS
Eliquis (apixaban) is a blood thinner medication used to help prevent harmful blood clots from forming in your body. It works by blocking a specific clotting factor, which reduces your risk of stroke if you have an irregular heartbeat (atrial fibrillation), or helps prevent and treat clots in your legs (DVT) and lungs (PE), especially after certain surgeries.APIXABAN has 10 documented drug interactions in our database, including 0 contraindicated, 10 major, 0 moderate, and 0 minor interactions.
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Contraindicated
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Moderate
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Minor
Combining naproxen with apixaban significantly increases your risk of bleeding, particularly in the stomach and intestines. This interaction can lead to serious and potentially life-threatening bleeding episodes.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Apixaban, a direct oral anticoagulant, inhibits factor Xa, preventing thrombin generation and clot formation. Their combined antihemostatic effects lead to an additive increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. Studies show that concurrent use of NSAIDs with DOACs can increase the risk of major bleeding by 1.5 to 2-fold compared to DOACs alone. Concurrent use of naproxen and apixaban should generally be avoided due to the high bleeding risk. If pain management is necessary, consider alternative analgesics such as acetaminophen. If an NSAID is absolutely required, use the lowest effective dose for the shortest possible duration, and monitor closely for signs of bleeding. Patients should be educated on bleeding symptoms and advised to seek immediate medical attention if they occur.
Combining etodolac with apixaban significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor will likely recommend avoiding this combination.
Mechanism
Etodolac, a nonsteroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal protection and platelet aggregation. Apixaban is a direct oral anticoagulant (DOAC) that directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use of an NSAID with an anticoagulant leads to an additive effect on bleeding risk due to impaired hemostasis and direct gastrointestinal irritation.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding (e.g., stomach ulcers, melena, hematemesis), but also other sites like intracranial hemorrhage. Studies show a 2-4 fold increased risk of major bleeding when NSAIDs are co-administered with DOACs compared to DOACs alone, with GI bleeding being the most common. Symptoms may include black, tarry stools, vomiting blood, or unusual bruising. This combination should generally be avoided due to the high risk of serious bleeding. If an NSAID is absolutely necessary, consider alternatives with lower GI risk (e.g., celecoxib if cardiovascular risk is acceptable) or topical NSAIDs, and use for the shortest duration possible with close monitoring for bleeding. Proton pump inhibitors (PPIs) should be co-prescribed to reduce GI bleeding risk. Regular monitoring for signs of bleeding is crucial. If pain management is needed, acetaminophen or opioid analgesics may be safer alternatives.
Combining aspirin with apixaban significantly increases your risk of bleeding, including serious internal bleeding. Your doctor will weigh the benefits against this high risk.
Mechanism
Aspirin, particularly at higher doses, inhibits platelet aggregation and can cause gastrointestinal irritation. Apixaban directly inhibits Factor Xa, preventing clot formation. The concurrent use of these agents leads to a synergistic impairment of hemostasis, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of hemorrhage, including gastrointestinal bleeding, intracranial hemorrhage, and other major bleeding events. Studies show a significantly higher rate of major bleeding with combined therapy compared to either drug alone, potentially increasing major bleeding risk by 2-3 times. Concurrent use should generally be avoided unless the cardiovascular benefit clearly outweighs the bleeding risk, such as in specific high-risk cardiovascular conditions. If co-administration is deemed necessary, use the lowest effective dose of aspirin (e.g., 81 mg) and monitor patients closely for signs of bleeding. Consider gastroprotective agents like proton pump inhibitors.
Combining ibuprofen with apixaban significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided.
Mechanism
Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), inhibits platelet aggregation and can cause direct irritation and damage to the gastrointestinal lining. Apixaban is a direct oral anticoagulant (DOAC) that prevents blood clotting by inhibiting Factor Xa. Their combined use results in an additive antiplatelet and anticoagulant effect, disrupting normal hemostasis.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. The risk of major gastrointestinal bleeding can be 3 to 15 times higher when NSAIDs are combined with anticoagulants compared to anticoagulants alone. This combination should generally be avoided due to the high bleeding risk. If pain management is necessary, consider alternative analgesics such as acetaminophen. If an NSAID is absolutely required, use the lowest effective dose for the shortest duration, and monitor closely for signs of bleeding (e.g., black/tarry stools, unusual bruising, blood in urine). Proton pump inhibitor co-therapy may be considered to reduce GI bleeding risk.
Combining indomethacin with apixaban significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal defense and inhibit platelet aggregation. Apixaban is a direct oral anticoagulant that directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use leads to additive antiplatelet and anticoagulant effects, alongside increased gastrointestinal mucosal damage from the NSAID.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other systemic bleeding events. Studies show that combining NSAIDs with anticoagulants can increase the risk of GI bleeding by 3 to 15 times compared to anticoagulants alone. This combination should generally be avoided due to the high bleeding risk. If pain management is necessary, consider alternative analgesics such as acetaminophen or opioids. If an NSAID is absolutely essential and no other alternative exists, use the lowest effective dose for the shortest duration, and consider gastroprotective agents (e.g., proton pump inhibitors). Closely monitor for signs of bleeding.
Combining celecoxib with apixaban significantly increases your risk of serious bleeding, including internal bleeding. Your doctor will likely recommend avoiding this combination.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which impairs platelet aggregation and damages the gastrointestinal mucosa, increasing bleeding risk. Apixaban is a direct oral anticoagulant that directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use of these agents results in additive antihemostatic effects.
Clinical Management
This combination substantially increases the risk of major bleeding events, including gastrointestinal bleeding, intracranial hemorrhage, and other site-specific bleeding. Studies show a significantly elevated risk of major bleeding (e.g., 2-4 fold higher) compared to anticoagulant monotherapy, particularly in the GI tract. Avoid concurrent use of celecoxib and apixaban. If an analgesic is required, consider acetaminophen or opioid analgesics as alternatives. If NSAID use is absolutely unavoidable and the benefits outweigh the risks, use the lowest effective dose for the shortest duration, and monitor closely for signs of bleeding. Consider proton pump inhibitor co-therapy to mitigate GI bleeding risk.
Combining piroxicam, an anti-inflammatory pain reliever, with apixaban, a blood thinner, significantly increases your risk of serious bleeding, including stomach bleeding.
Mechanism
Piroxicam inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation, which prolongs bleeding time. Apixaban directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use results in additive antiplatelet and anticoagulant effects.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding, which can be severe or even fatal. Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by approximately 2-3 fold compared to DOACs alone. Concurrent use of piroxicam and apixaban should generally be avoided due to the high bleeding risk. If pain management is necessary, consider alternative analgesics such as acetaminophen. If an NSAID is absolutely required, choose one with a shorter half-life and lower GI risk (e.g., ibuprofen for a short duration), and monitor closely for signs of bleeding. Proton pump inhibitor prophylaxis should be considered if an NSAID is unavoidable.
Combining meloxicam with apixaban significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to the serious bleeding potential.
Mechanism
Meloxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal protection and inhibit platelet aggregation. Apixaban is a direct oral anticoagulant (DOAC) that inhibits Factor Xa, preventing clot formation. The concurrent use leads to additive antiplatelet and anticoagulant effects, alongside increased gastrointestinal mucosal damage from the NSAID.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding, particularly gastrointestinal bleeding (e.g., stomach ulcers, melena, hematemesis). Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by 2-3 fold compared to DOACs alone, with a significant portion being GI bleeds. Other potential bleeding sites include intracranial hemorrhage or genitourinary bleeding. This combination should generally be avoided. If an NSAID is absolutely necessary, consider alternative pain management strategies first. If no other option exists, use the lowest effective dose of meloxicam for the shortest possible duration, and monitor closely for any signs of bleeding. Proton pump inhibitor (PPI) co-prescription may reduce GI bleeding risk but does not eliminate it. Regular blood count monitoring is advisable. Consider alternative analgesics like acetaminophen.
Combining diclofenac, an NSAID, with apixaban, a blood thinner, significantly increases your risk of serious bleeding, especially in the stomach or intestines. Your doctor will likely recommend avoiding this combination.
Mechanism
Diclofenac inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, which impairs platelet aggregation and damages the gastrointestinal mucosa. Apixaban directly inhibits Factor Xa, preventing thrombin generation and clot formation. The combination results in additive antiplatelet and anticoagulant effects, alongside increased gastrointestinal vulnerability.
Clinical Management
This combination significantly elevates the risk of major bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other serious bleeding. Studies show a 2-4 fold increased risk of major bleeding compared to apixaban alone, with GI bleeding being the most common. Symptoms may include black, tarry stools, vomiting blood, or unusual bruising. This combination should generally be avoided due to the high risk of severe bleeding. If an NSAID is absolutely necessary, consider alternatives like acetaminophen for pain relief. If NSAID use is unavoidable, use the lowest effective dose for the shortest duration, and monitor closely for signs of bleeding. Proton pump inhibitors (PPIs) may be considered to reduce GI bleeding risk, but do not eliminate it.
Combining ketorolac (an NSAID) with apixaban (a blood thinner) significantly increases your risk of serious bleeding, including stomach bleeding. This combination should generally be avoided.
Mechanism
Ketorolac inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis, which impairs platelet aggregation and can damage the gastrointestinal mucosa. Apixaban directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, leading to a heightened risk of hemorrhage.
Clinical Management
Patients are at a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can manifest as black or tarry stools, vomiting blood, or severe abdominal pain. Other potential bleeding sites include the brain, urinary tract, and soft tissues. The risk of major bleeding can be several-fold higher compared to using either drug alone. This combination is generally contraindicated due to the high risk of severe bleeding. If an NSAID is absolutely necessary, consider alternatives with lower systemic absorption (e.g., topical NSAIDs for localized pain) or alternative pain management strategies. Close monitoring for signs of bleeding is essential if no alternative can be found, but this is strongly discouraged. Consult with a healthcare professional to explore safer pain relief options.
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