Apixaban and Collagenase, Clostridium Histolyticum: 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
Collagenase, Clostridium Histolyticum
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 that helps prevent dangerous clots. Collagenase (Clostridium histolyticum) is an injection used to break down tough cords of tissue, like in Dupuytren's contracture or Peyronie's disease. After that injection, some bruising and bleeding at the site is normal.
The concern is that a blood thinner could make that bleeding or bruising worse. This warning is based on caution rather than strong studies, but bleeding is serious, so it is taken seriously. Please don't stop either medicine on your own. Talk with your doctor or pharmacist before any collagenase injection so they can plan the timing safely and watch you closely.
Effect: Additive bleeding risk. Apixaban is a direct factor Xa inhibitor (not a prodrug); collagenase clostridium histolyticum enzymatically lyses collagen, causing local tissue disruption and expected injection-site bleeding/bruising. Concurrent anticoagulation compounds bleeding potential (pharmacodynamic, altered coagulation).
- Direction: Increased bleeding, particularly at injection site.
- Evidence: Theoretical; no formal interaction studies in patients on anticoagulants within 7 days prior.
- Severity/onset: Major; onset unspecified.
- Management: Avoid concomitant use with anticoagulants (except low-dose aspirin) in patients with abnormal coagulation. Coordinate timing and monitor closely if collagenase is planned; individualize per care team.
What happens
Increased risk of bleeding adverse effects
Interaction Deep Dive
In patients with abnormal coagulation, the simultaneous use of collagenase clostridium histolyticum together with an anticoagulant (other than low-dose aspirin) should be avoided, since it raises the likelihood of bleeding events. No interaction studies have been performed in patients who received anticoagulant drugs during the 7 days before collagenase clostridium histolyticum was given1.
Why it happens (mechanism)
Altered coagulation
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise. This is something they can plan around.
- Tell the clinician giving the collagenase injection that you take apixaban (Eliquis).
- Guidance is to avoid combining an anticoagulant with collagenase when coagulation is abnormal, so your team may adjust the timing of your apixaban around the injection and monitor you more closely.
- Watch for and report unusual bruising, swelling, prolonged bleeding, or bleeding at the injection site.
Raise any questions about timing or dosing with your pharmacist or prescriber before the procedure.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Collagenase, Clostridium Histolyticum together?
Combining apixaban with a collagenase injection can raise bleeding risk, especially at the injection site. Tell your care team you take apixaban before any collagenase treatment so they can time it safely and monitor you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Collagenase, Clostridium Histolyticum 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 Collagenase, Clostridium Histolyticum interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise. This is something they can plan around. Tell the clinician giving the collagenase injection that you take apixaban (Eliquis). Guidance is to avoid combining an anticoagulant with collagenase when coagulation is abnormal, so your team may adjust the timing of your apixaban around the injection and monitor you more clo… 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 Collagenase, Clostridium Histolyticum 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: XIAFLEX(R) intralesional injection solution, collagenase clostridium histolyticum intralesional injection solution. Auxilium Pharmaceuticals, Inc. (per manufacturer), Chesterbrook, PA, 2013.
Keep reading about Apixaban
Keep reading about Collagenase, Clostridium Histolyticum
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