Apixaban and Boceprevir: 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
Boceprevir
No brand names on recordApixaban
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.
Here's what's going on. Apixaban (Eliquis) is a blood thinner that helps prevent clots. Boceprevir slows down two of the systems your body uses to clear apixaban out. When that clearing slows, more apixaban builds up in your blood, so it can thin your blood more than intended.
The main worry here is bleeding, things like easy bruising, nosebleeds, or bleeding that is hard to stop. The good news is your care team can manage this. Depending on your dose, they may lower it or watch you more closely. Please don't stop or change either medicine on your own. Just talk with your pharmacist or doctor so they can tailor your plan.
Mechanism: Boceprevir is a combined strong CYP3A4 and P-gp inhibitor. Apixaban is a substrate of both, so inhibition reduces its metabolism and efflux, increasing exposure and bleeding risk. Neither drug is a prodrug; the interaction increases apixaban effect.
Magnitude (surrogate, ketoconazole): Cmax +62%, AUC +97%.
- Evidence: probable; severity: major; onset: unspecified.
- Management: Avoid concomitant use if apixaban is dosed 2.5 mg PO BID. For 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, concurrent administration should be avoided. When apixaban is given at higher doses (namely 5 or 10 mg twice daily), reduce the dose by 50% if a combined P-gp and strong CYP3A4 inhibitor is used at the same time. Because apixaban is metabolized as a substrate of both CYP3A4 and P-gp, giving it together with an agent that inhibits both P-gp and CYP3A4 can raise apixaban exposure and thereby elevate the potential for bleeding12. A pharmacokinetic study demonstrated that coadministration with ketoconazole (a combined P-gp and strong CYP3A4 inhibitor) produced a 62% rise in apixaban Cmax and a 97% rise in AUC3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism; inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
The situation is manageable with your care team's help. Based on the documented guidance:
- If you take apixaban 2.5 mg twice daily, this combination is generally avoided, so your prescriber may choose a different plan.
- If you take 5 mg or 10 mg twice daily, your dose may be reduced by half while you are on boceprevir.
- Keep taking both exactly as prescribed until your care team advises otherwise.
Ask your pharmacist or doctor before starting these together, and watch for unusual bruising, bleeding gums, nosebleeds, or bleeding that won't stop. Report these right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) When apixaban was given together with ketoconazole, apixaban Cmax rose by 62% and apixaban AUC rose by 97% relative to apixaban given by itself. In 18 subjects, a single oral dose of apixaban 10 mg was given 4 days after starting ketoconazole 400 mg once daily 3.
b) A drug interaction study found that 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 Apixaban and Boceprevir together?
Boceprevir can raise apixaban levels and increase bleeding risk, so your care team may avoid the combination at low apixaban doses or cut higher doses in half. Do not change anything yourself; check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Boceprevir 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 Boceprevir interaction managed?
The situation is manageable with your care team's help. Based on the documented guidance: If you take apixaban 2.5 mg twice daily, this combination is generally avoided, so your prescriber may choose a different plan. If you take 5 mg or 10 mg twice daily, your dose may be reduced by half while you are on boceprevir. Keep taking both exactly as prescribed until your care team advises otherwise. As… 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 Apixaban or Boceprevir 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 Boceprevir
Keep reading about Apixaban
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