9 Eliquis Interactions You Should Know About

GoodRx Health

Eliquis (apixaban) is a medication that treats and prevents unwanted blood clots. It belongs to a class of medications known as direct-acting oral anticoagulants (DOACs). Like all medications, Eliquis can interact with the other medications and supplements you take. This can affect how well Eliquis works, or it can raise your risk of side effects.

Below, we'll review nine Eliquis interactions to be aware of and how to manage them. Keep in mind, this list doesn't include all medications or supplements that can interact with Eliquis. Your healthcare team can review your medication list for any other interactions that may be an issue for you.

1. Aspirin and other NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can raise your risk of bleeding - especially if you take them with blood thinners such as Eliquis. NSAIDs include common over-the-counter (OTC) medications, such as ibuprofen (Advil) and naproxen (Aleve).

It's best to avoid NSAIDs while taking Eliquis. If you're in need of an OTC pain or fever medication, talk to your healthcare team about safer options for your symptoms.

Good to know:Low-dose aspirin is an NSAID commonly used for heart protection. Certain people may benefit from taking low-dose aspirin and Eliquis at the same time. But this combination can also raise your bleeding risk. You should only take these medications together if your prescriber tells you to do so.

Can you take Tylenol with Eliquis?

Tylenol (acetaminophen) isn't an NSAID. So it doesn't raise your bleeding risk if you take it with Eliquis. But Tylenol isn't the best choice for everyone, including people with liver problems. Check with your prescriber or pharmacist to make sure Tylenol is a safe option for you before taking it with Eliquis.

2. Warfarin and other prescription blood thinners

Warfarin (Coumadin, Jantoven) is another common blood thinner. It works differently than Eliquis and also has a high risk of bleeding. Eliquis and warfarin shouldn't be taken together, because the risk of serious bleeding events is too high. This also applies to combining Eliquis with other prescription blood thinners, in most cases.

It's possible that you may need to switch from warfarin to Eliquis, or the other way around. If you need to make this switch, your prescriber will help you do so safely.

Good to know: Most of the time, it's best to avoid taking any other blood thinners with Eliquis. But in certain cases, it may be necessary. Clopidogrel (Plavix) is an example of a blood thinner that your healthcare professional may have you take with Eliquis in certain cases. But this can still raise your risk of bleeding events. You should only take more than one blood thinner if your prescriber recommends it. Make sure you understand exactly how to take them, and contact your healthcare team if you have any questions.

3. Some antidepressants, such as fluoxetine

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant medications. Examples include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

SSRIs can raise your risk of bleeding. This risk is even higher if you take them with a blood thinner, such as Eliquis.

Your prescriber may decide it's OK for you to take an SSRI with Eliquis. But they'll have you keep an eye out for any signs of bleeding, such as nosebleeds or bleeding gums after brushing your teeth. Be sure to let them know if you notice these signs if you're taking an SSRI and Eliquis together.

4. Ketoconazole and itraconazole

The antifungal medications ketoconazole and itraconazole (Sporanox) are widely known for having interactions with other medications. They're strong blockers of liver enzymes (proteins) that process medications. These medications can block the breakdown of Eliquis, which raises its levels in your body. This leads to a higher risk of Eliquis side effects, especially bleeding.

If you need to take one of these antifungal medications, your prescriber may change your Eliquis dosage. Be sure to follow their instructions carefully.

5. Phenytoin and other antiseizure medications

Certain antiseizure medications, such as phenytoin (Dilantin) or carbamazepine (Tegretol), can lower the amount of Eliquis in your body. This makes it less effective at preventing blood clots.

It's best to avoid taking Eliquis with phenytoin or carbamazepine. If you're already taking one of these medications, your prescriber may recommend a different blood thinner for you. If you need to start an antiseizure medication while taking Eliquis, your prescriber will likely choose one that doesn't interact. Just be sure they're aware you're taking Eliquis.

6. Diltiazem

Diltiazem (Cardizem) belongs to a class of medications called calcium channel blockers. It's taken for high blood pressure and other heart-related conditions. Diltiazem can increase Eliquis levels in your body, which puts you at a greater risk for bleeding.

Even though they interact, there may be times when your prescriber recommends taking both diltiazem and Eliquis. If so, be sure to follow their instructions carefully. And let them know right away if you notice any signs of abnormal bleeding.

7. Rifampin

Rifampin is an antibiotic used to treat tuberculosis and other bacterial infections. Rifampin can lower Eliquis levels in your body. This can make Eliquis less effective at preventing blood clots.

It's best to avoid this combination. But if rifampin is the only treatment option, your prescriber may make changes to your Eliquis dose. They may also switch you to a different blood thinner altogether.

8. Paxlovid and other antiviral medications

Paxlovid (nirmatrelvir / ritonavir) is an antiviral medication used to treat COVID-19. And it can block the breakdown of Eliquis in your body. This leads to greater bleeding risks.

Typically, Paxlovid is only taken for 5 days. But it's still possible for it to cause higher levels of Eliquis in your body during that time. Make sure your prescriber knows you're taking Eliquis before starting Paxlovid. They can make sure it's safe for you to take and adjust your Eliquis dose if needed.

Other antiviral medications can interact with Eliquis in the same way as Paxlovid. These include protease inhibitors used to treat HIV, such as:

• Ritonavir (Norvir)

• Atazanavir (Reyataz)

• Lopinavir / ritonavir (Kaletra)

Since these are long-term medications, your prescriber will likely choose a different blood thinner for you that doesn't interact with them.

9. St. John's wort

St. John's wort is a common herbal supplement used to help manage symptoms of depression and menopause. It's known to interact with a variety of medications - and Eliquis is one of them. St. John's wort can make Eliquis less effective. This could put you at risk for blood clots.

You should avoid St. John's wort while taking Eliquis. Talk to your healthcare team about safer options for your symptoms.

When should I contact my healthcare team about an Eliquis interaction?

You should talk to your healthcare team before starting or stopping any medications or supplements while taking Eliquis. They can help you make any changes safely.

It's also a good idea to let your healthcare team know if you notice any mild signs of bleeding while taking Eliquis. These can include bleeding gums, minor bruising, or nosebleeds. They may need to adjust your Eliquis dose.

More serious bleeding needs medical attention right away. Symptoms include:

• Bleeding that doesn't stop

• Large bruises that don't heal

• Blood in your urine

• Blood in your stool (may be bright red or black)

• Coughing up or vomiting blood

You should also be aware of the symptoms of a blood clot. Seek emergency care if you notice any of the following:

• Sudden swelling, pain, or redness in your arm or leg

• Difficulty breathing

• Fast or irregular heartbeat

• Chest pain

• Low blood pressure

Frequently asked questions

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