Apixaban and Floctafenine: 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
Floctafenine
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.
Taking these two together can raise your risk of bleeding. Apixaban (Eliquis) is a blood thinner, and floctafenine is an anti-inflammatory pain reliever (an NSAID). Each one can make bleeding more likely on its own, and together the effect adds up. That could mean things like easier bruising, nosebleeds, or more serious internal bleeding.
This warning is based mostly on how these medicines work rather than large studies, but bleeding is worth taking seriously. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, and let them know right away if you notice unusual bruising, blood in your urine or stool, or bleeding that won't stop. Your care team can manage this safely.
Effect: Additive risk of serious bleeding when apixaban (a direct factor Xa inhibitor) is combined with floctafenine (an NSAID).
- Mechanism: Pharmacodynamic, additive impairment of hemostasis (anticoagulation plus NSAID effects on platelets and GI mucosa). Not a CYP-based PK interaction; neither agent's activation is at issue here.
- Direction/magnitude: Increased bleeding risk; magnitude not quantified.
- Onset: Unspecified. Evidence: Theoretical.
- Management: If used concurrently, monitor for signs/symptoms of bleeding (GI, mucocutaneous, drops in Hgb/Hct). Heightened caution with neuraxial anesthesia or spinal puncture given risk of spinal/epidural hematoma. Consider alternative analgesia (e.g., non-NSAID) per prescriber judgment.
What happens
An increased risk of bleeding
Interaction Deep Dive
Using an anticoagulant together with an NSAID can raise the likelihood of serious bleeding compared with taking either agent by itself1234, and in patients undergoing neuraxial anesthesia or spinal puncture it can heighten the chance of epidural or spinal hematomas, which may lead to prolonged 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
The good news: this is manageable with your care team. Keep taking both medicines exactly as prescribed unless your doctor or pharmacist tells you otherwise.
- Your team may watch you more closely for bleeding, and they may choose a different pain reliever if a safer option fits your needs.
- Tell your prescriber if you are scheduled for any spinal procedure or epidural, since combining these medicines raises the risk of a spinal blood clot in that setting.
- Call your doctor promptly for unusual bruising, nosebleeds, pink or red urine, black or bloody stools, or bleeding that won't stop.
Raise any questions with your pharmacist, who can review your full medication list.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Floctafenine together?
Combining apixaban with the NSAID floctafenine adds up to a higher bleeding risk, so keep both as prescribed but watch for bleeding and check with your pharmacist or doctor, especially before any spinal procedure. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Floctafenine 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 Floctafenine interaction managed?
The good news: this is manageable with your care team. Keep taking both medicines exactly as prescribed unless your doctor or pharmacist tells you otherwise. Your team may watch you more closely for bleeding, and they may choose a different pain reliever if a safer option fits your needs. Tell your prescriber if you are scheduled for any spinal procedure or epidural, since combining these medicine… 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 Floctafenine 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 Floctafenine
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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