Apixaban and Amtolmetin Guacil: 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
Amtolmetin Guacil
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.
Eliquis (apixaban) is a blood thinner, and amtolmetin guacil is an anti-inflammatory pain reliever (an NSAID, in the same family as ibuprofen). Each one, on its own, can make bleeding more likely. Taken together, they can add up and raise your chance of bleeding a bit more.
This is mostly a caution based on how these drugs work, not on a specific problem we've measured with this exact pair. The good news is your care team can manage it. Watch for things like unusual bruising, nosebleeds, pink or red urine, black stools, or bleeding that won't stop, and tell your pharmacist or doctor right away. Don't stop either medicine on your own, just check in with your team.
Mechanism: additive effect on hemostasis. Apixaban (a direct factor Xa inhibitor) plus amtolmetin guacil (an NSAID with antiplatelet activity and GI mucosal effects) produces a pharmacodynamic, not pharmacokinetic, increase in bleeding risk. Neither is a prodrug relevant to this interaction's direction.
- Direction: increased bleeding risk versus either agent alone.
- Severity/evidence: major, but theoretical (mechanism-based).
- Special risk: spinal/epidural hematoma with neuraxial anesthesia or spinal puncture.
- Management: if used together, monitor for overt and occult bleeding (CBC/Hgb, signs of GI bleed); consider gastroprotection and alternative analgesia. Doses may be individualized by the care team.
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 taking either agent 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 prolonged or permanent paralysis5. When these agents are given at the same time, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
If your team decides you should take both, keep taking them exactly as prescribed unless told otherwise. The main plan here is watching more closely for bleeding.
- Report bruising, nosebleeds, bleeding gums, blood in urine or stool, black stools, vomiting blood, or unusual tiredness or dizziness.
- Tell any surgeon, dentist, or anesthesiologist you take both, especially before a spinal injection, epidural, or spinal tap.
- Ask your pharmacist or doctor whether a stomach-protecting medicine or a different pain reliever might be a better fit for you.
Your care team may adjust or individualize your treatment and monitor you more closely to keep this safe.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Amtolmetin Guacil together?
Combining the blood thinner apixaban with the NSAID amtolmetin guacil can add up to a higher bleeding risk, so watch closely for signs of bleeding and check with your pharmacist or doctor before changing anything. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Amtolmetin Guacil 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 Amtolmetin Guacil interaction managed?
If your team decides you should take both, keep taking them exactly as prescribed unless told otherwise. The main plan here is watching more closely for bleeding. Report bruising, nosebleeds, bleeding gums, blood in urine or stool, black stools, vomiting blood, or unusual tiredness or dizziness. Tell any surgeon, dentist, or anesthesiologist you take both, especially before a spinal injection, epi… 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 Amtolmetin Guacil 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 Amtolmetin Guacil
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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