Apixaban and Aceclofenac: 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
Aceclofenac
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, and aceclofenac is an anti-inflammatory pain reliever (an NSAID). Both can make it harder for your blood to clot and can irritate the stomach lining. When you take them together, the effects add up, so your risk of bleeding goes up. This could show as easy bruising, nosebleeds, bleeding gums, or something more serious like stomach bleeding.
This is a caution based on how these drugs work, not on a proven set number. Please don't stop either medicine on your own. Talk with your pharmacist or doctor. They can decide the safest plan and watch you more closely so this stays well managed.
Effect: Additive bleeding risk when combining apixaban (a direct factor Xa inhibitor) with aceclofenac (an NSAID). Neither is a prodrug here; the interaction is pharmacodynamic, not metabolic.
- Mechanism: Additive impairment of hemostasis (anticoagulation plus NSAID-mediated platelet inhibition and GI mucosal injury).
- Direction: Increased bleeding risk vs. either agent alone; heightened risk of epidural/spinal hematoma with neuraxial anesthesia or spinal puncture.
- Severity/evidence: Major, theoretical. Onset unspecified.
- Management: Avoid if possible; if combined, monitor for overt and occult bleeding (CBC, signs/symptoms), review GI protection, and exercise caution around neuraxial procedures.
What happens
An increased risk of bleeding
Interaction Deep Dive
Taking an anticoagulant together with an NSAID can raise the likelihood of serious bleeding compared with either agent used by itself1234, and in patients receiving neuraxial anesthesia or undergoing spinal puncture it can heighten the risk of epidural or spinal hematomas, which may lead to long-term or permanent paralysis5. When these drugs are given at the same time, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise. Because a blood thinner and an NSAID together raise bleeding risk, your team may take steps to keep you safe.
- They may reassess whether you need the NSAID, or consider an alternative pain option.
- They may add stomach protection and monitor you more closely.
- Tell them before any spinal or epidural procedure, since this combination raises the risk of a spinal bleed.
Call your pharmacist or doctor right away if you notice unusual bruising, black or bloody stools, pink or red urine, vomit that looks like coffee grounds, or bleeding that won't stop.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Aceclofenac together?
Taking Eliquis with the NSAID aceclofenac adds up to a higher bleeding risk, so keep both as prescribed but ask your pharmacist or doctor whether the combination is right for you and watch for any signs of bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Aceclofenac 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 Aceclofenac interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise. Because a blood thinner and an NSAID together raise bleeding risk, your team may take steps to keep you safe. They may reassess whether you need the NSAID, or consider an alternative pain option. They may add stomach protection and monitor you more closely. Tell them before any spinal or epidural procedure, since thi… 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 Aceclofenac 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 Aceclofenac
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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