Eliquis Drug Interactions: What You Need to Know

Eliquis (Apixaban) is a blood thinner that millions of Americans rely on to prevent strokes and treat blood clots. But like most medications, Eliquis can interact with other drugs, supplements, and even certain foods — sometimes in dangerous ways.

Knowing what interacts with Eliquis can help you stay safe and get the most benefit from your treatment. This guide covers the major and moderate interactions you should be aware of in 2026.

How Drug Interactions Work with Eliquis

Eliquis is processed in your body by two systems: an enzyme called CYP3A4 and a protein called P-glycoprotein (P-gp). These systems break down and transport the drug through your body.

When another medication affects CYP3A4 or P-gp, it can change how much Eliquis stays in your bloodstream:

• Inhibitors (drugs that block CYP3A4/P-gp) can increase Eliquis levels — raising your bleeding risk.
• Inducers (drugs that speed up CYP3A4/P-gp) can decrease Eliquis levels — making it less effective and increasing your clot risk.

Some interactions are serious enough to require a dose change or mean you should avoid the combination entirely.

Major Drug Interactions

These medications have significant interactions with Eliquis and may require dose adjustments or should be avoided:

Strong CYP3A4 and P-gp Inhibitors (Increase Eliquis Levels)

Taking these with Eliquis raises the amount of Apixaban in your blood, increasing bleeding risk. Your doctor may reduce your Eliquis dose to 2.5 mg twice daily:

• Ketoconazole (Nizoral) — antifungal
• Itraconazole (Sporanox) — antifungal
• Ritonavir (Norvir) — HIV protease inhibitor
• Clarithromycin (Biaxin) — antibiotic

Strong CYP3A4 and P-gp Inducers (Decrease Eliquis Levels)

These medications speed up Eliquis metabolism, potentially making it ineffective. Avoid taking these with Eliquis:

• Rifampin (Rifadin) — antibiotic for tuberculosis
• Carbamazepine (Tegretol) — seizure medication
• Phenytoin (Dilantin) — seizure medication
• St. John's Wort — herbal supplement for depression

Other Anticoagulants (Increased Bleeding Risk)

Taking Eliquis with other blood thinners dramatically increases the risk of major bleeding:

• Warfarin (Coumadin, Jantoven)
• Heparin (including Enoxaparin/Lovenox)

In most cases, you should not take Eliquis with another anticoagulant. If you're switching from one blood thinner to another, your doctor will manage the transition carefully.

Antiplatelet Medications (Increased Bleeding Risk)

These drugs also prevent clotting and increase bleeding risk when combined with Eliquis:

• Aspirin — especially at doses above 81 mg daily
• Clopidogrel (Plavix)
• Prasugrel (Effient)

Some patients with heart stents may need to take Aspirin and Eliquis together under close medical supervision. Never start or stop Aspirin without your doctor's guidance.

Moderate Drug Interactions

These interactions are less severe but still worth monitoring:

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Common pain relievers that increase bleeding risk when taken with Eliquis:

• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)
• Diclofenac (Voltaren)
• Meloxicam (Mobic)

If you need pain relief, ask your doctor about safer alternatives like Acetaminophen (Tylenol), which doesn't affect clotting the same way.

SSRIs and SNRIs (Antidepressants)

These medications can thin the blood slightly on their own and may increase bleeding risk when combined with Eliquis:

• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)

This doesn't mean you can't take an antidepressant with Eliquis — many patients do safely. But your doctor should know about both medications.

Diltiazem (Cardizem)

Diltiazem is a calcium channel blocker used for blood pressure and heart rhythm. It's a moderate CYP3A4 inhibitor that may modestly increase Eliquis levels. Your doctor may monitor you more closely but usually won't need to change your dose.

Supplements and Over-the-Counter Products to Watch

Some supplements and OTC products can interact with Eliquis:

• St. John's Wort — A strong CYP3A4 inducer. Avoid this supplement while taking Eliquis — it can make the medication less effective.
• Fish oil / Omega-3 supplements — May have mild blood-thinning effects at high doses. Tell your doctor if you take these.
• Vitamin E — High doses may increase bleeding risk.
• Ginkgo biloba — Has antiplatelet properties and may increase bleeding.
• Garlic supplements — In concentrated form, may have mild blood-thinning effects.
• Turmeric / Curcumin — May have anticoagulant properties at high doses.

Always tell your doctor and pharmacist about every supplement you take — even if it seems harmless.

Food and Drink Interactions

Eliquis has far fewer food interactions than older blood thinners like Warfarin. Here's what to know:

• Grapefruit and grapefruit juice: Grapefruit is a moderate CYP3A4 inhibitor and may modestly increase Eliquis levels. Occasional consumption is generally fine, but avoid drinking large amounts regularly.
• Alcohol: While there's no direct drug interaction, alcohol can increase bleeding risk and affect liver function. Limit alcohol intake while on Eliquis.
• No vitamin K restriction: Unlike Warfarin, you don't need to limit foods rich in vitamin K (like spinach, kale, or broccoli) while taking Eliquis.

What to Tell Your Doctor

Before starting Eliquis — or any time your medications change — make sure your doctor and pharmacist know about:

• All prescription medications you currently take
• Over-the-counter drugs including pain relievers, cold medicines, and antacids
• Vitamins and supplements including herbal products
• Any upcoming procedures — you may need to temporarily stop Eliquis before surgery or dental work
• Kidney or liver problems — these can affect how your body processes Eliquis

Keeping a current medication list on your phone or in your wallet is a simple way to make sure nothing gets missed — especially in emergencies.

Final Thoughts

Eliquis is generally well-tolerated and has fewer interactions than Warfarin, but that doesn't mean it's interaction-free. The biggest risks come from other blood thinners, strong CYP3A4/P-gp inhibitors and inducers, and common pain relievers like Ibuprofen. Being upfront with your healthcare team about everything you take is the best way to stay safe.

For more about Eliquis, read our guides on side effects, how it works, or how to save money on your prescription. If you need help finding Eliquis at a pharmacy, Medfinder can help you locate it in stock near you.