Apixaban and Crizotinib: 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
Crizotinib
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. Crizotinib (Xalkori) can slow down a transporter in your body that normally helps clear apixaban out. When that transporter is blocked, more apixaban can stay in your blood than expected.
That means the blood thinner may act stronger than intended, which can raise your chance of bleeding, things like easy bruising, nosebleeds, or bleeding that is slow to stop. The good news is this is something your care team can plan for. Please don't stop either medicine on your own. Just talk with your doctor or pharmacist so they can decide the safest approach for you.
Mechanism: Crizotinib inhibits P-glycoprotein (P-gp), reducing efflux transport of apixaban (a P-gp substrate), which may increase apixaban exposure (AUC/Cmax) and bleeding risk. Neither agent is activated by this pathway, so the effect is a straightforward increase in anticoagulant exposure.
- Direction: increased apixaban effect (bleeding risk).
- Severity: major; onset: unspecified.
- Evidence: theoretical.
- Management: Per label, coadministration is generally to be avoided. If combined, monitor closely for bleeding; dose may need individualization by the care team. Consider anticoagulant alternatives where appropriate.
What happens
Increased apixaban exposure
Interaction Deep Dive
Apixaban is a substrate of P-gp, while crizotinib acts as a P-gp inhibitor; taking them together can raise apixaban concentrations and heighten the likelihood of bleeding, so the combination should not be used1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
What your care team may do:
- Because this pairing can raise apixaban levels and bleeding risk, the guidance on file is that this combination is generally best avoided, so your team may consider a different blood thinner or a different plan.
- If both are needed, your dose may be adjusted and individualized, and your team may monitor you more closely for bleeding.
What you can do:
- Keep taking both exactly as prescribed until your care team tells you otherwise.
- Report any unusual bruising, nosebleeds, blood in urine or stool, or bleeding that won't stop.
- Ask your pharmacist or doctor whether this combination is right for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Crizotinib together?
Crizotinib can raise apixaban levels and increase bleeding risk, so this combination is generally avoided. Don't change anything yourself; ask your doctor or pharmacist to review your regimen. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Crizotinib 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 Crizotinib interaction managed?
What your care team may do: Because this pairing can raise apixaban levels and bleeding risk, the guidance on file is that this combination is generally best avoided, so your team may consider a different blood thinner or a different plan. If both are needed, your dose may be adjusted and individualized, and your team may monitor you more closely for bleeding. What you can do: Keep taking both exa… 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 Crizotinib 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)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
Keep reading about Crizotinib
Keep reading about Apixaban
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