Apixaban and Choline Salicylate: 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
Choline Salicylate
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 choline salicylate is a salicylate pain reliever that works much like aspirin and other NSAIDs. Both can affect how your blood clots. When taken together, they can add up and raise your chance of bleeding, which could show up as easy bruising, nosebleeds, pink or red urine, black stools, or bleeding that is slow to stop.
This is a caution based on how the two drugs work rather than on lots of hard studies, so please don't panic. Don't stop either medicine on your own. Talk with your pharmacist or doctor so they can weigh the risk and watch you more closely.
Effect: Additive risk of bleeding from concurrent anticoagulant (apixaban, a direct factor Xa inhibitor) and NSAID/salicylate (choline salicylate).
- Mechanism: Additive/pharmacodynamic effect on hemostasis. Apixaban impairs coagulation; salicylates impair platelet function and can injure GI mucosa. Neither is a prodrug here; this is PD, not PK.
- Direction/magnitude: Increased bleeding risk versus either agent alone; magnitude unspecified.
- Onset: Unspecified. Evidence: Theoretical.
- Management: Monitor for signs of bleeding (GI, mucosal, neurologic). Heightened vigilance for spinal/epidural hematoma with neuraxial anesthesia or spinal puncture. Consider gastroprotection or alternative analgesia if appropriate.
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 the two are given at the same time, watch for signs of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
The main concern is added bleeding risk, so your care team's job is to keep an eye out and tailor your treatment.
- Keep taking both exactly as prescribed unless your doctor or pharmacist tells you otherwise.
- Your team may monitor you more closely for signs of bleeding and may adjust or choose a different pain reliever if that fits your situation.
- Watch for and report: unusual bruising, nosebleeds, bleeding gums, pink/red urine, black or bloody stools, or vomit that looks like coffee grounds.
- If you have any spinal procedure or epidural planned, tell that team you take both medicines, because of a rare risk of spinal bleeding.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Choline Salicylate together?
Taking Eliquis with choline salicylate can add up to a higher bleeding risk, so keep both as prescribed but watch closely for bleeding and check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Choline Salicylate 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 Choline Salicylate interaction managed?
The main concern is added bleeding risk, so your care team's job is to keep an eye out and tailor your treatment. Keep taking both exactly as prescribed unless your doctor or pharmacist tells you otherwise. Your team may monitor you more closely for signs of bleeding and may adjust or choose a different pain reliever if that fits your situation. Watch for and report: unusual bruising, nosebleeds,… 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 Choline Salicylate 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 Choline Salicylate
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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