Adagrasib 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
Adagrasib
Apixaban
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.
Taking Adagrasib (Krazati) with Apixaban (Eliquis) can raise the amount of the blood thinner in your body. Adagrasib slows down the enzyme and the transporter that normally help clear apixaban, so more of it can build up. Apixaban is already a blood thinner, so higher levels mean a greater chance of bleeding, like easy bruising, nosebleeds, or bleeding that is hard to stop.
The good news is your care team can manage this. They may lower your apixaban dose or watch you more closely for signs of bleeding. Please don't change anything on your own. Just talk with your pharmacist or doctor so they can tailor your plan safely.
Effect: Increased apixaban exposure and elevated bleeding risk.
Mechanism: Adagrasib is a combined P-gp and strong CYP3A4 inhibitor. Apixaban is a substrate of both CYP3A4 and P-gp (not a prodrug), so inhibition reduces clearance and increases exposure. With ketoconazole (a comparable combined inhibitor), apixaban Cmax rose 62% and AUC 97%.
Evidence: Probable; severity major.
- Apixaban 2.5 mg BID: avoid concomitant use.
- Apixaban 5 or 10 mg BID: reduce dose by 50%.
- Monitor for signs and symptoms of bleeding.
What happens
Increased apixaban exposure and an increased risk of bleeding
Interaction Deep Dive
In patients taking apixaban at 2.5 mg orally twice daily, steer clear of concurrent administration. For patients on higher apixaban regimens (that is, 5 or 10 mg twice daily), reduce the dose by 50% when a combined P-gp and strong CYP3A4 inhibitor is used at the same time. Because apixaban is a substrate of both CYP3A4 and P-gp, combining it with an agent that inhibits both P-gp and CYP3A4 (strongly) can raise apixaban exposure and thereby heighten bleeding risk12. When apixaban was given together with ketoconazole (a combined P-gp and strong CYP3A4 inhibitor) in a pharmacokinetic study, apixaban Cmax rose by 62% and AUC by 97%3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism; inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
Keep taking both medications exactly as prescribed unless your care team tells you otherwise. This combination is manageable with the right dose and monitoring.
- Your team may lower your apixaban dose. For higher doses (5 or 10 mg twice daily), a 50% reduction is typical; low-dose apixaban (2.5 mg twice daily) is generally avoided with this combination.
- They may monitor you more closely for bleeding.
- Watch for and report unusual bruising, nosebleeds, pink or red urine, black stools, or bleeding that won't stop.
Ask your pharmacist or prescriber before changing anything.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) When apixaban and ketoconazole were given together, apixaban Cmax rose by 62% and apixaban AUC rose by 97% relative to apixaban given by itself. A single oral dose of apixaban 10 mg was given 4 days after starting ketoconazole 400 mg once daily in 18 subjects 3.
b) In a drug interaction study, giving apixaban together with ketoconazole 400 mg increased apixaban Cmax and AUC by roughly 1.6-fold and 2-fold, respectively 2.
Common questions
Can I take Adagrasib and Apixaban together?
Adagrasib can raise apixaban levels and increase bleeding risk, so your doctor may reduce your apixaban dose or watch you more closely. Report any unusual bleeding and don't change your doses on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Adagrasib 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 Adagrasib and Apixaban interaction managed?
Keep taking both medications exactly as prescribed unless your care team tells you otherwise. This combination is manageable with the right dose and monitoring. Your team may lower your apixaban dose. For higher doses (5 or 10 mg twice daily), a 50% reduction is typical; low-dose apixaban (2.5 mg twice daily) is generally avoided with this combination. They may monitor you more closely for bleedin… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Adagrasib 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 (3)
- Product Information: ELIQUIS(R) oral tablets, tablets for suspension, apixaban oral tablets, tablets for suspension. Bristol-Myers Squibb Company (per Manufacturer), Princeton, NJ, 2025. DailyMed
- Product Information: ELIQUIS(R) oral film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
- Frost CE, Byon W, Song Y, et al: Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79(5):838-846.
Keep reading about Adagrasib
Keep reading about Apixaban
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