Apixaban and Dipyrone: 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
Dipyrone
No brand names on recordApixaban
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.
Taking these two together can raise your risk of bleeding. Apixaban (Eliquis) is a blood thinner that helps prevent dangerous clots. Dipyrone is a pain and fever medicine that can also affect how your blood clots and can irritate the stomach lining. When you use them at the same time, their effects on bleeding can add up, so you may bruise more easily or bleed more than usual.
The good news is that this is a known, manageable situation. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, and watch for warning signs like unusual bruising, black or bloody stools, pink or red urine, or bleeding that won't stop.
Effect: Additive risk of serious bleeding when dipyrone (an NSAID/analgesic) is combined with apixaban, a direct factor Xa inhibitor.
- Mechanism: Additive PD effect on hemostasis; no primary PK interaction implied. Neither agent requires this pathway for activation.
- Direction: Increased bleeding risk versus either drug alone.
- Evidence: Theoretical; severity rated major. Onset unspecified.
- Management: Monitor for signs/symptoms of bleeding (GI, mucosal, hematuria). Heightened vigilance for epidural/spinal hematoma with neuraxial anesthesia or spinal puncture. Individualize therapy and consider alternative analgesia if appropriate.
What happens
An increased risk of bleeding
Interaction Deep Dive
Using an anticoagulant together with an NSAID can raise the likelihood of significant bleeding compared with taking either agent by itself1234, and in patients receiving neuraxial anesthesia or undergoing spinal puncture it can heighten the chance of epidural or spinal hematomas, which may lead to long-lasting or permanent paralysis5. When the two are given together, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
This interaction can usually be managed with monitoring. If your care team decides you should take both, they may watch you more closely for bleeding and tailor your plan to you.
- Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Watch for unusual bruising, nosebleeds, bleeding gums, black or bloody stools, red or pink urine, or coughing up blood.
- Tell your care team before any spinal or epidural procedure, since these carry a special bleeding risk.
- Ask your pharmacist whether a different pain reliever might be a safer fit for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Dipyrone together?
Combining dipyrone with apixaban can add to your bleeding risk, so watch for signs of bleeding and check with your pharmacist or doctor about the safest pain relief option. Do not stop either medicine on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Dipyrone 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 Dipyrone interaction managed?
This interaction can usually be managed with monitoring. If your care team decides you should take both, they may watch you more closely for bleeding and tailor your plan to you. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Watch for unusual bruising, nosebleeds, bleeding gums, black or bloody stools, red or pink urine, or coughing up blood. Tell you… 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 Dipyrone 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 Dipyrone
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.
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