Apixaban and Abiraterone Acetate, Micronized: 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
Abiraterone Acetate, Micronized
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.
You've been prescribed abiraterone (for prostate cancer) along with apixaban (Eliquis), a blood thinner. Abiraterone may block a natural "pump" in your body called P-gp that normally helps clear apixaban out. When that pump is slowed, more apixaban can build up in your blood.
More apixaban means a higher chance of bleeding, such as easy bruising, nosebleeds, bleeding gums, or blood in your urine or stool. This concern is based on theory rather than solid studies, but because bleeding can be serious, it's worth taking seriously. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, who can decide the safest plan for you.
Effect: Increased apixaban exposure via abiraterone's inhibition of P-gp mediated efflux (apixaban is a P-gp substrate). Neither drug is a prodrug relevant to this pathway; the net effect is higher apixaban plasma levels and increased bleeding risk.
- Direction: Increased apixaban AUC/Cmax, enhanced anticoagulant effect.
- Evidence: Theoretical; magnitude not quantified.
- Onset: Unspecified.
- Management: Product labeling advises avoiding coadministration. If both are considered necessary, the anticoagulation plan should be individualized by the care team, with closer monitoring for bleeding (hemoglobin/hematocrit, signs of hemorrhage).
What happens
Increased apixaban exposure
Interaction Deep Dive
Taking apixaban, which is a substrate of P-gp, together with abiraterone, a possible P-gp inhibitor, could raise apixaban concentrations and heighten the likelihood of bleeding; for this reason, using them together should be avoided1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
Here's how a care team typically handles this combination:
- Because abiraterone can raise apixaban levels, the guidance on file is to avoid using them together when possible.
- If your team decides you need both, your dose may be adjusted and individualized, and they may monitor you more closely for signs of bleeding.
- Keep taking both exactly as prescribed until your prescriber tells you otherwise.
Contact your pharmacist or doctor promptly if you notice unusual bruising, bleeding that won't stop, pink or red urine, black stools, or severe headache or dizziness.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Abiraterone Acetate, Micronized together?
Abiraterone may raise apixaban levels and increase bleeding risk, so this combination is generally avoided; if both are prescribed, don't stop either drug on your own but ask your care team to confirm the plan and watch for bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Abiraterone Acetate, Micronized 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 Apixaban and Abiraterone Acetate, Micronized interaction managed?
Here's how a care team typically handles this combination: Because abiraterone can raise apixaban levels, the guidance on file is to avoid using them together when possible. If your team decides you need both, your dose may be adjusted and individualized, and they may monitor you more closely for signs of bleeding. Keep taking both exactly as prescribed until your prescriber tells you otherwise. C… 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 Apixaban or Abiraterone Acetate, Micronized 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 (1)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
Keep reading about Abiraterone Acetate, Micronized
Keep reading about Apixaban
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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