Apixaban and Bromfenac: 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
Bromfenac
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 bromfenac is an NSAID (a type of anti-inflammatory). Both can make it a little harder for your blood to clot. When you use them together, that effect can add up, so there may be a somewhat higher chance of bleeding, like easy bruising, nosebleeds, or stomach bleeding.
Bromfenac usually comes as eye drops, so very little gets into your bloodstream, which helps. Still, it is smart to be aware. The good news is your care team can manage this by keeping an eye on you. Please don't stop either medicine on your own. Just watch for unusual bruising or bleeding and let your pharmacist or doctor know if you notice anything.
Effect: Additive risk of bleeding when combining an anticoagulant (apixaban, direct factor Xa inhibitor) with an NSAID (bromfenac).
Mechanism: Pharmacodynamic, additive impairment of hemostasis. Neither drug is a prodrug; this is a PD interaction, not a PK enzyme effect. Bromfenac's ophthalmic formulation limits systemic exposure, reducing but not eliminating concern.
- Direction: Increased bleeding risk
- Onset: Unspecified
- Evidence: Theoretical
- Severity: Major, particularly regarding spinal/epidural hematoma with neuraxial anesthesia or spinal puncture
Management: Monitor for signs of bleeding. Exercise heightened caution around neuraxial procedures.
What happens
An increased risk of bleeding
Interaction Deep Dive
Using an NSAID together with an anticoagulant 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 long-term or permanent paralysis 5. When the two are given concurrently, watch for signs of bleeding 124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this combination with closer attention.
- Watch for bleeding: unusual bruising, nosebleeds, bleeding gums, pink or red urine, black or bloody stools, or coughing/vomiting blood.
- Speak up before procedures: tell any provider doing a spinal injection, spinal tap, or spinal/epidural anesthesia that you take both, because of a rare risk of spinal bleeding.
- Check in: ask your pharmacist or doctor whether monitoring or any adjustment is right for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Bromfenac together?
Using apixaban with bromfenac can add up to a higher bleeding risk, so watch for unusual bruising or bleeding and tell any provider before spinal procedures. Keep taking both as prescribed and check in with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Bromfenac 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 Bromfenac interaction managed?
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this combination with closer attention. Watch for bleeding: unusual bruising, nosebleeds, bleeding gums, pink or red urine, black or bloody stools, or coughing/vomiting blood. Speak up before procedures: tell any provider doing a spinal injection, spinal tap, or spin… 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 Bromfenac 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 Bromfenac
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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