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Three Rx pill bottles: Eliquis interactions
Drug Info

Eliquis interactions to avoid

Eliquis can interact with several OTC and Rx medications. Here’s what you should not take with Eliquis to avoid side effects.
Keith Gardner, RPh, medical writer and reviewer for SingleCare
By | Jan. 18, 2024

Key takeaways

  • Eliquis is a prescription medicine used to lower the risk of stroke or blood clots in people with a heart rhythm disorder called atrial fibrillation and to reduce the risk of forming a blood clot in the legs and lungs, particularly in those who have just had hip or knee replacement surgery.

  • Care should be taken when combining Eliquis with aspirin, NSAIDs, other prescription drugs to treat blood clots, SSRIs, SSNIs, and any drugs that inhibit or induce the enzyme CYP3A4.

  • It is very important to tell your healthcare provider about any other prescription medications you may be taking and over-the-counter drugs, vitamins, herbs, and other supplements.

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Eliquis, the branded version of the drug apixaban, is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to:

  1. Reduce the risk of stroke and blood clots in people who have irregular heart rhythms, a condition known as atrial fibrillation or Afib.
  2. To reduce the risk of forming a blood clot in the legs and lungs following hip replacement or knee replacement surgery.
  3. To treat and prevent blood clots forming in the veins of the legs (deep vein thrombosis or DVT) or lungs (pulmonary embolism).

Eliquis, a member of a group of drugs called factor Xa inhibitors, works by blocking proteins that cause blood to clot.  

While Eliquis can be an effective treatment option for many people, there are potential drug interactions that may occur. Because Eliquis is a blood thinner medicine that reduces blood clotting, it may cause bleeding, which can be serious and, rarely, fatal. Other medicines that also increase the risk of bleeding may cause an additional risk of serious bleeding if taken at the same time as Eliquis. These include:

  • Aspirin or aspirin-containing products
  • Long-term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Other medications used to help prevent or treat blood clots
  • Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Certain antibiotics, antivirals, and antifungals are known as inhibitors of CYP3A4 (an enzyme that allows the body to remove drugs or toxins)
  • Certain antituberculosis and anticonvulsant medicines, which are known as inducers of CYP3A4

It is important to be aware of how Eliquis may affect the action of other drugs and how other drugs (and foods) may affect Eliquis.

Eliquis drug interactions

There are several prescription and over-the-counter (OTC) drugs that can interact with Eliquis. Some may increase the risk of serious bleeding, which is an adverse effect associated with Eliquis. Conversely, when Eliquis is combined with certain medicines, notably other anticoagulants, it may increase the risk of the side effects of these other drugs. Drug interactions may also adversely affect the blood levels of Eliquis and reduce its effectiveness.

To avoid drug-drug interactions, be sure to discuss all of the prescription and OTC medications you take with your healthcare provider.

Aspirin and aspirin-containing products

Because one of the effects of aspirin is to stop blood from clotting, it alone may result in bleeding more easily. Because of this, using Eliquis combined with aspirin may increase the risk of bleeding even more, including the possibility of severe and sometimes fatal bleeding. Aspirin should not be taken together with an anticoagulant such as Eliquis unless a healthcare professional has specifically prescribed it.

Most OTC aspirin products plainly list it as the active ingredient (e.g., Bayer Aspirin, Ecotrin, and Bufferin). However, many multi-symptom medicines that contain aspirin are more apparent when reading the fine print. These include multi-ingredient medicines such as Coricidin, Alka Seltzer Plus Cold, and Excedrin PM. It is important to examine the list of ingredients to avoid aspirin-containing products when taking Eliquis.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Much like aspirin, NSAIDs are pain relievers and can affect the blood’s ability to clot, particularly when taken over a longer time. NSAIDs may increase the risk of bleeding, particularly in the digestive tract, and this risk is greatly increased when NSAIDs are taken with Eliquis. Members of this class of drugs include the following (generic names followed by common brand names): 

NSAIDs are obvious ingredients in OTC medicines, but not always–be sure to read the fine print carefully. It is important to talk to your healthcare provider before taking any of these drugs in combination with Eliquis.

Other anti-clotting medications

There are different classes of anti-clotting medications, and none are recommended to be used with Eliquis because they share the same adverse effect of increased risk of bleeding. Anticoagulants, such as heparin or warfarin (Coumadin, Jantoven), slow down the body’s process of making clots. Antiplatelet drugs, such as clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient), cilostazol (Pletal), and dipyridamole, prevent blood cells called platelets from clumping together to form a clot. Factor Xa inhibitors (a class which includes Eliquis) work by blocking proteins that cause blood to clot. Other members of this class include edoxaban (Savaysa), fondaparinux (Arixtra), and rivaroxaban (Xarelto).

Before taking Eliquis, tell your healthcare provider if you’re already taking an anti-clotting medication.

Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)

SSRIs and SNRIs can prevent platelets from grouping to form clots in the blood, which can increase the risk of bleeding. When Eliquis is taken with an SSRI or SNRI, the risk of bleeding can grow even more. Members of these classes of drugs include the following (generic names followed by common brand names):

Before taking Eliquis, make sure your healthcare provider knows if you’re taking an antidepressant.

Inhibitors and inducers of CYP3A4

Cytochrome P450 3A4 (CYP3A4) is an important enzyme in the body that helps break down small foreign molecules, such as drugs so that they can be eliminated from the body. Drugs that are CYP3A4 inhibitors can increase the risk of bleeding by increasing the blood levels of Eliquis. In contrast, drugs that are CYP3A4 inducers can speed up the elimination of Eliquis and reduce its effectiveness, thereby increasing the risk of stroke or blood clots.

Drugs that are CYP3A4 inhibitors include:

Drugs that are CYP3A4 inducers include:

Eliquis food interactions

According to the product labeling, Eliquis can be taken with or without food as it does not affect its absorption into the bloodstream.

Eliquis and grapefruit 

Grapefruit and grapefruit juice interact with the effectiveness of many medicines due to binding to the enzyme CYP3A4. When taken together, grapefruit blocks the enzyme and raises the level of Eliquis in the bloodstream, increasing the risk of bleeding.

Other Eliquis interactions

Eliquis and vitamins/herbal supplements

There are no specific warnings of vitamins interacting with Eliquis. Eliquis may interact with the herbal supplement St. John’s wort. Taking Eliquis with this supplement can significantly reduce the medicine’s blood levels and make it less effective in preventing blood clots.

How to minimize Eliquis interactions

Keep an updated list of all the pharmaceuticals, vitamins, and supplements you take and all your medical conditions. Before starting Eliquis, give this list to your healthcare provider and pharmacist. Your pharmacist can also provide a medication guide to give drug information and help avoid drug-drug interactions.

This article is a partial list of all Eliquis interactions. Hence, it is important to communicate openly with your healthcare providers about all medications, vitamins, and supplements you take to ensure proper medical advice and monitoring.

When to talk to a healthcare provider about Eliquis interactions

Contact your healthcare provider or seek medical help if you have any of these signs or symptoms of bleeding when taking Eliquis:

  • Unexpected bleeding, or bleeding that lasts a long time, such as:
    • unusual bleeding from the gums
    • nosebleeds that happen often
    • menstrual bleeding or vaginal bleeding that is heavier than normal
  • Bleeding that is severe, or you cannot control
  • Red, pink, or brown urine
  • Red or black stools (looks like tar)
  • Cough up blood or blood clots
  • Vomit blood or your vomit looks like coffee grounds
  • Unexpected pain, swelling, or joint pain
  • Headaches, feeling dizzy or weak