Acemetacin and Apixaban: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Aug 8, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Apixaban
Acemetacin
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Apixaban (Eliquis) is a blood thinner that helps prevent dangerous clots. Acemetacin is an anti-inflammatory painkiller (an NSAID, similar to ibuprofen). When you take them together, they can both work on your body's ability to stop bleeding, so the risk of bleeding goes up compared to taking either one alone.
This can show up as easy bruising, nosebleeds, bleeding gums, or more serious internal bleeding. The good news is your care team can manage this. Please don't stop either medicine on your own. Let your pharmacist or doctor know you take both, and tell them right away if you notice unusual bleeding.
Effect: Additive bleeding risk when apixaban (a direct factor Xa inhibitor) is combined with acemetacin (an NSAID). Neither is a prodrug in a way that alters direction; this is a pharmacodynamic interaction, not a metabolic one.
- Mechanism: additive effect on hemostasis (anticoagulation plus NSAID effects on platelets and GI mucosa).
- Direction: increased bleeding risk, including GI bleeding and, with neuraxial anesthesia or spinal puncture, epidural/spinal hematoma.
- Evidence: theoretical; severity: major; onset unspecified.
- Management: avoid or minimize concomitant NSAID use if possible; monitor for signs/symptoms of bleeding and hemoglobin. Exercise particular caution around neuraxial procedures.
What happens
An increased risk of bleeding
Interaction Deep Dive
When an anticoagulant is given together with an NSAID, the likelihood of serious bleeding may rise compared with taking either agent by itself1234, and in patients receiving neuraxial anesthesia or undergoing spinal puncture, the combination may heighten the risk of epidural or spinal hematomas, which can lead to prolonged or permanent paralysis 5. Should the two be administered concurrently, watch for indications of bleeding 124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this combination.
- Your team may monitor you more closely for bleeding, and may choose a different pain reliever if one is suitable for you.
- Watch for unusual bruising, nosebleeds, bleeding gums, pink or red urine, black or bloody stools, or coughing/vomiting blood.
- If you are scheduled for any spinal injection, epidural, or spinal tap, make sure that team knows you take both drugs.
- Ask your pharmacist before adding any over-the-counter NSAID (like ibuprofen or naproxen).
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acemetacin and Apixaban together?
Combining apixaban with the NSAID acemetacin raises bleeding risk, so watch for any unusual bleeding and talk with your pharmacist or doctor before changing anything or adding other pain relievers. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acemetacin and Apixaban interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Acemetacin and Apixaban interaction managed?
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this combination. Your team may monitor you more closely for bleeding, and may choose a different pain reliever if one is suitable for you. Watch for unusual bruising, nosebleeds, bleeding gums, pink or red urine, black or bloody stools, or coughing/vomiting blood. I… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Acemetacin or Apixaban need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
- Product Information: CELEBREX(R) oral capsules, celecoxib oral capsules. GD Searle LLC (per FDA), New York, NY, 2016. DailyMed
- Product Information: COUMADIN(R) oral tablets, intravenous injection powder for solution, warfarin sodium oral tablets, intravenous injection powder for solution. Bristol-Myers Squibb Company (per manufacturer), Princeton, NJ, 2015. DailyMed
- Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023. DailyMed
- Product Information: PRADAXA(R) oral capsules, dabigatran etexilate oral capsules. Boehringer Ingelheim Pharmaceuticals Inc (per FDA), Ridgefield, CT, 2023. DailyMed
Keep reading about Apixaban
Keep reading about Acemetacin
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