Apixaban and Clarithromycin: 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
Clarithromycin
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.
Here's what's going on. Apixaban (Eliquis) is a blood thinner. Clarithromycin (Biaxin) can slow down how your body clears apixaban, so a bit more can build up in your blood. In theory, that could raise your chance of bleeding, like easy bruising, nosebleeds, or bleeding that is slow to stop.
The reassuring part: studies of these two together showed only a small rise in apixaban levels, so for most people no dose change is needed. Your care team can manage this by watching you a little more closely. Keep taking both as prescribed, and let your pharmacist or doctor know if you notice any unusual bleeding.
Mechanism: Clarithromycin is a strong CYP3A4 inhibitor and a P-gp inhibitor. Apixaban is a substrate of both. Neither drug is a prodrug, so inhibition increases apixaban exposure and theoretical bleeding risk.
- Magnitude: Apixaban Cmax ~1.4-fold and AUC ~1.5-fold in a PK study.
- Evidence: Probable; severity moderate.
- Direction: Increased apixaban effect.
Management: Although the general rule for combined P-gp/strong CYP3A4 inhibitors is to avoid at apixaban 2.5 mg BID or halve higher doses, clarithromycin appears to be an exception; PK data suggest no apixaban dose adjustment is necessary. Monitor for signs of bleeding.
What happens
Increased apixaban exposure and an increased risk of bleeding
Interaction Deep Dive
Apixaban is metabolized by CYP3A4 and transported by P-gp, so giving it alongside an agent that inhibits both P-gp and CYP3A4 strongly, such as clarithromycin, can raise apixaban levels and heighten the potential for bleeding. As a general rule, this combination should be avoided in patients taking apixaban 2.5 mg orally twice daily, while higher apixaban regimens (that is, 5 or 10 mg twice daily) should be reduced by 50% when a combined P-gp and strong CYP3A4 inhibitor is used concurrently. Clarithromycin, however, may represent an exception, since pharmacokinetic evidence indicates that no change in apixaban dosing is required with concurrent use. In a drug interaction study, giving apixaban together with clarithromycin 500 mg raised apixaban Cmax by roughly 1.4-fold and AUC by roughly 1.5-fold1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of apixaban; inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
What your care team may do:
- Often no dose change is needed with clarithromycin specifically, since the increase in apixaban levels is small.
- Your team may monitor you a bit more closely for bleeding during the antibiotic course.
- Any dose decision will be individualized by your prescriber.
What you should do:
- Keep taking both medications exactly as prescribed unless told otherwise.
- Tell your pharmacist or doctor you take Eliquis before starting Biaxin.
- Report unusual bruising, nosebleeds, pink or red urine, black stools, or bleeding that won't stop.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a study of drug interactions, giving apixaban together with clarithromycin, 500 mg, led to an increase in apixaban Cmax and AUC of about 1.4-fold and 1.5-fold, respectively 1.
Common questions
Can I take Apixaban and Clarithromycin together?
Clarithromycin can modestly raise apixaban levels and bleeding risk, but studies suggest no dose change is usually needed with this specific antibiotic. Keep taking both as prescribed and watch for any unusual bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Clarithromycin interaction?
It is rated moderate. Can be significant — usually manageable with 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 Clarithromycin interaction managed?
What your care team may do: Often no dose change is needed with clarithromycin specifically, since the increase in apixaban levels is small. Your team may monitor you a bit more closely for bleeding during the antibiotic course. Any dose decision will be individualized by your prescriber. What you should do: Keep taking both medications exactly as prescribed unless told otherwise. Tell your pharma… 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 Clarithromycin 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 anything you'd monitor while I'm on both?
References (1)
- Product Information: ELIQUIS(R) oral film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
Keep reading about Clarithromycin
Keep reading about Apixaban
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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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