Key takeaways:
Eliquis (apixaban) is a blood thinner taken to prevent blood clots in certain people. Eliquis interactions can make blood clots more likely or increase your risk of a serious bleeding event.
Nonsteroidal anti-inflammatory drugs (NSAIDs), other blood thinners, and some antidepressants can raise your risk of bleeding if combined with Eliquis. The same is true if you take Eliquis with alcohol, grapefruit, or grapefruit juice.
Cardizem (diltiazem) and some antiviral and antifungal medications can raise Eliquis levels in the body. St. John’s wort, certain antiseizure medications, and Rifadin (rifampin) can lower Eliquis levels and make blood clots more likely.
Tell your healthcare team about any supplements and medications you’re taking before starting Eliquis. They can check for any Eliquis interactions you should be aware of.
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.
Eliquis interactions at a glance
Below is a list of common Eliquis interactions to be aware of. Keep in mind, this list doesn’t include every medication or supplement that can interact with Eliquis. Your healthcare team can review your medication list for any other interactions that may be an issue for you.
Eliquis interactions include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Other blood thinners
Ketoconazole
Sporanox (itraconazole)
Dilantin (phenytoin)
Tegretol (carbamazepine)
Cardizem (diltiazem)
Rifaadin (rifampin)
Paxlovid (nirmatrelvir / ritonavir)
Norvir (ritonavir)
Reyataz (atazanavir)
Kaletra (lopinavir / ritonavir)
St. John’s wort
Supplements that can raise your bleeding risk, such as turmeric, ginkgo biloba, and ginger
Grapefruit and grapefruit juice
Alcohol
Let’s take a closer look at 11 Eliquis interactions to avoid.
1. Aspirin and other NSAIDs
NSAIDs can raise your risk of bleeding — especially if you take them with Eliquis or other blood thinners. NSAIDs include common over-the-counter (OTC) pain medications, such as Advil (ibuprofen), Aleve (naproxen), and aspirin. Many prescription-only NSAIDs are also available.
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.
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 has a high risk of bleeding. You shouldn’t take Eliquis and warfarin together. The risk of serious bleeding is too high with this combination.
This also applies to combining Eliquis with other prescription blood thinners, in most cases. Examples include:
Xarelto (rivaroxaban)
Pradaxa (dabigatran)
Savaysa (edoxaban)
Arixtra (fondaparinux)
Lovenox (enoxaparin)
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. Plavix (clopidogrel) 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
SSRIs are a class of antidepressant medications that can interact with Eliquis. Examples include:
Prozac (fluoxetine)
Zoloft (sertraline)
Paxil (paroxetine)
Eliquis (apixaban) side effects: Learn what to expect — and what to look out for — when taking Eliquis.
Xarelto (rivaroxaban) vs. Eliquis: Learn how these two blood thinners compare.
What foods should you avoid with Eliquis? Read pharmacist-approved answers to this and more Eliquis FAQs.
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 or symptoms 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.
Seek emergency care if signs of serious bleeding appear, such as:
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
4. Ketoconazole and itraconazole
The oral antifungal medications ketoconazole and Sporanox are widely known for having interactions with other medications. They’re strong blockers of certain liver enzymes (proteins) that process medications. This means that these antifungal 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 temporarily change your Eliquis dosage. Be sure to follow their instructions carefully.
5. Phenytoin and other antiseizure medications
Certain antiseizure medications, such as Dilantin or 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. Cardizem
Cardizem belongs to a class of medications called calcium channel blockers. It’s taken for high blood pressure and other heart-related conditions. Diltiazem (the active ingredient in Cardizem) 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 is an antiviral medication used to treat COVID-19. It can block the breakdown of Eliquis in your body. This leads to greater bleeding risks.
Typically, you’ll only take Paxlovid 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:
Norvir
Reyataz
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. OTC supplements, such as St. John’s wort and turmeric
St. John’s wort is a common herbal supplement marketed to help manage symptoms of depression. 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.
Other supplements can raise your bleeding risk, especially if you combine them with a prescription blood thinner. Examples include ginkgo biloba, ginger, and turmeric. Omega-3 or fish oil and vitamin E supplements also carry this risk. Talk to your pharmacist or prescriber before taking any OTC supplements with Eliquis.
10. Grapefruit and grapefruit juice
Eliquis interactions also include grapefruit and grapefruit juice. Grapefruit blocks the enzyme that breaks down Eliquis to remove it from the body. So it can increase Eliquis levels and raise your risk of bleeding if they’re combined.
A small amount of grapefruit or grapefruit juice now and then is likely fine. But you shouldn’t consume it often or in large amounts.
11. Alcohol
There isn’t a direct interaction between Eliquis and alcohol. But alcohol can raise your risk of bleeding. And this risk is even higher when it’s combined with a blood thinner, such as Eliquis.
It’s best to limit your alcohol intake while taking Eliquis. A moderate amount of alcohol (1 or 2 drinks in a day) now and then isn’t likely to be an issue. But consuming more than that could become a problem.
Talk to your healthcare team if you have questions about how much alcohol is safe to drink while taking Eliquis. They can help you understand the risks and provide resources if you need help cutting back.
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
Frequently asked questions
Yes, it’s typically OK to take prednisone with Eliquis if your prescriber recommends it. There isn’t a significant interaction between the two medications. But it’s a good idea to take these medications with food, since both can cause nausea as a side effect.
It’s possible, but the evidence isn’t clear one way or the other. Large amounts of cranberry juice or cranberry supplements may raise your bleeding risk. They also seem to interact with warfarin (Coumadin, Jantoven), a different type of blood thinner than Eliquis. There isn’t any evidence that cranberries interact with Eliquis. But it’s best to check with your prescriber before taking cranberry supplements or drinking large amounts of cranberry juice while you’re taking it.
Leg swelling isn’t a reported side effect of Eliquis. But it can be a sign of a blood clot in your leg, known as a deep vein thrombosis (DVT). Signs and symptoms of a DVT include swelling in one leg that’s red and warm to the touch. If this happens while taking Eliquis, seek emergency care as soon as possible.
Yes, Eliquis may cause dizziness and confusion for some people. This side effect seems to be more likely in older adults, but it’s considered a rare side effect overall. Keep in mind that these symptoms can also be a sign of bleeding in the brain. So if they appear suddenly, or if you have other signs of bleeding, seek medical care right away.
Eliquis isn’t affected by your diet the way that warfarin is. So broccoli and leafy greens aren’t an issue. But there are some foods that can raise your bleeding risk if you eat them in large amounts while taking Eliquis. Examples include garlic, grapeseed oil, and cayenne pepper.
Yes, it’s typically OK to take prednisone with Eliquis if your prescriber recommends it. There isn’t a significant interaction between the two medications. But it’s a good idea to take these medications with food, since both can cause nausea as a side effect.
It’s possible, but the evidence isn’t clear one way or the other. Large amounts of cranberry juice or cranberry supplements may raise your bleeding risk. They also seem to interact with warfarin (Coumadin, Jantoven), a different type of blood thinner than Eliquis. There isn’t any evidence that cranberries interact with Eliquis. But it’s best to check with your prescriber before taking cranberry supplements or drinking large amounts of cranberry juice while you’re taking it.
Leg swelling isn’t a reported side effect of Eliquis. But it can be a sign of a blood clot in your leg, known as a deep vein thrombosis (DVT). Signs and symptoms of a DVT include swelling in one leg that’s red and warm to the touch. If this happens while taking Eliquis, seek emergency care as soon as possible.
Yes, Eliquis may cause dizziness and confusion for some people. This side effect seems to be more likely in older adults, but it’s considered a rare side effect overall. Keep in mind that these symptoms can also be a sign of bleeding in the brain. So if they appear suddenly, or if you have other signs of bleeding, seek medical care right away.
Eliquis isn’t affected by your diet the way that warfarin is. So broccoli and leafy greens aren’t an issue. But there are some foods that can raise your bleeding risk if you eat them in large amounts while taking Eliquis. Examples include garlic, grapeseed oil, and cayenne pepper.
The bottom line
Eliquis (apixaban) interactions include nonsteroidal anti-inflammatory drugs (NSAIDs), other blood thinners, and some antidepressants. There’s an increased risk of bleeding if you take these medications with Eliquis. Alcohol, some over-the-counter supplements, and grapefruit or grapefruit juice can also increase your bleeding risk if you combine them with Eliquis.
Cardizem (diltiazem) and some antiviral and antifungal medications can raise Eliquis levels in the body. Other Eliquis interactions, such as St. John’s wort, certain antiseizure medications, and Rifadin (rifampin) can lower Eliquis levels and make blood clots more likely.
Be sure to tell your healthcare team about all the medications and supplements you take. And don't make changes to your medications without talking to your prescriber first.
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References
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Rahman, A. A., et al. (2024). Concomitant use of selective serotonin reuptake inhibitors with oral anticoagulants and risk of major bleeding. JAMA Network Open.
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