Apixan Drug Interactions

Inhibitors of both CYP3A4 and P-gp increase exposure to apixaban and increase the risk of bleeding because apixaban is a substrate of both CYP3A4 and P-gp.
For patients receiving apixaban 5 mg or 10 mg twice daily, the dose of apixaban should be decreased by 50% when co-administered with drugs that are strong inhibitors of CYP3A4 and P-gp (e.g., ketoconazole, itraconazole, ritonavir, or clarithromycin).
For patients already receiving apixaban at a dose of 2.5 mg twice daily, avoid co-administration with strong dual inhibitors of CYP3A4 and P-gp.
Inducers of both CYP3A4 and P-gp, (e.g., rifampin, carbamazepine, phenytoin, St. John's wort) drugs will decrease exposure to apixaban and increase the risk of stroke and other thromboembolic events. Avoid concomitant use.
Co-administration of aspirin and other antiplatelet agents, fibrinolytics, heparin or other anticoagulants, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs) and NSAIDs use will increases the risk of bleeding.