Apixaban and Ceritinib: 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
Ceritinib
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.
Let's talk about taking ceritinib (Zykadia) together with apixaban (Eliquis). Ceritinib slows down a liver enzyme called CYP3A that normally helps clear apixaban out of your body. When apixaban is cleared more slowly, more of it can build up, and since apixaban is a blood thinner, that could raise your risk of bruising or bleeding.
This concern is mostly based on how these drugs work, not on lots of real-world reports, so please don't be alarmed. The most important thing is not to stop or change either medicine on your own. Your care team can manage this by adjusting your dose or watching you a bit more closely for any bleeding.
Effect: Ceritinib is a strong CYP3A inhibitor; apixaban is partly a CYP3A4 substrate, so coadministration may increase apixaban exposure (AUC/Cmax), raising bleeding risk. Neither drug is a prodrug, so this is a direct increase in active drug effect.
- Mechanism: inhibition of CYP3A-mediated apixaban metabolism.
- Magnitude: not established for apixaban; ceritinib raised midazolam AUC 5.4-fold, Cmax 1.8-fold.
- Onset: unspecified.
- Evidence: theoretical.
- Management: avoid sensitive CYP3A substrates; if used together, consider apixaban dose reduction and monitor for signs of bleeding.
What happens
Increased CYP3A substrate exposure
Interaction Deep Dive
When ceritinib, which strongly inhibits CYP3A, is taken together with a CYP3A substrate, the exposure to that substrate may rise. Giving it alongside midazolam, a sensitive CYP3A substrate, produced a 5.4-fold rise in midazolam AUC and a 1.8-fold rise in Cmax. Sensitive CYP3A substrates should not be used, and when other CYP3A substrates are given at the same time, reducing the dose of the CYP3A substrate should be considered1.
Why it happens (mechanism)
Inhibition of CYP3A-substrate metabolism by ceritinib
How to manage this interaction
Good news first: this is usually manageable, and you should keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your care team may adjust and individualize your apixaban dose while you are on ceritinib.
- They may monitor you more closely for signs of bleeding.
- Watch for and report: unusual bruising, nosebleeds, pink or red urine, black or bloody stools, or bleeding that won't stop.
Ask your pharmacist or doctor before starting any new medicine, and let them know you take both of these so they can tailor your plan.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) When a single dose of midazolam (a sensitive CYP3A substrate) was given after 3 weeks of ceritinib 750 mg daily under fasted conditions, the midazolam AUC rose by 5.4-fold and the Cmax rose by 1.8-fold relative to midazolam given by itself 1.
Common questions
Can I take Apixaban and Ceritinib together?
Ceritinib can slow the breakdown of apixaban, which may increase apixaban levels and bleeding risk, so your care team may lower the dose or watch you more closely; keep taking both as prescribed and report any unusual bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Ceritinib 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 Ceritinib interaction managed?
Good news first: this is usually manageable, and you should keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your care team may adjust and individualize your apixaban dose while you are on ceritinib. They may monitor you more closely for signs of bleeding. Watch for and report: unusual bruising, nosebleeds, pink or red urine, black or bloody stools, or b… 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 Ceritinib 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)
- Product Information: ZYKADIA(R) oral capsules, ceritinib oral capsules. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2019. DailyMed
Keep reading about Ceritinib
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist