Apixaban and Indinavir: 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
Indinavir
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 bleeding risk. Apixaban (Eliquis) is a blood thinner. Your body clears it using two systems, an enzyme called CYP3A4 and a transporter called P-gp. Indinavir slows both of these down, so more apixaban stays in your body than intended. That means the blood thinner can work too strongly.
Watch for signs like easy bruising, nosebleeds, pink or red urine, black stools, or bleeding that won't stop. Don't stop or change either medicine on your own. Your care team can manage this safely, often by adjusting your apixaban dose or choosing a different plan, so let your pharmacist or doctor know you take both.
Effect: Increased apixaban exposure and elevated bleeding risk.
Mechanism: Indinavir is a combined strong CYP3A4 and P-gp inhibitor. Apixaban is a substrate of both; dual inhibition reduces its metabolism and efflux, increasing exposure (neither drug here is a prodrug). Reference data with ketoconazole showed Cmax up ~62% and AUC up ~97%.
Evidence: Probable. Severity: Major. Onset unspecified.
- Avoid concomitant use when apixaban is dosed at 2.5 mg PO BID.
- For 5 or 10 mg BID regimens, reduce apixaban dose by 50% during coadministration.
- Monitor for signs and symptoms of bleeding.
What happens
Increased apixaban exposure and an increased risk of bleeding
Interaction Deep Dive
In patients taking apixaban at 2.5 mg orally twice daily, coadministration should be avoided. When apixaban is given at the higher doses (that is, 5 or 10 mg twice daily), the dose should be reduced by 50% if a combined P-gp and strong CYP3A4 inhibitor is used concurrently. Because apixaban is a substrate of both CYP3A4 and P-gp, using it together with an agent that inhibits both P-gp and CYP3A4 strongly can raise apixaban exposure and may heighten the risk of bleeding12. A pharmacokinetic study demonstrated that when apixaban was administered with ketoconazole (a combined P-gp and strong CYP3A4 inhibitor), apixaban Cmax rose by 62% and AUC rose by 97%3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism; inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
Good news: this is manageable with your care team. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- If you take apixaban at 2.5 mg twice daily, using it together with indinavir is generally avoided, so your team may pick an alternative.
- If you take 5 mg or 10 mg twice daily, your team may cut the apixaban dose in half while you are on indinavir.
- Expect closer monitoring for bleeding.
Tell your pharmacist and prescriber you take both, and report any unusual bruising or bleeding promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Giving apixaban together with ketoconazole produced a 62% rise in apixaban Cmax and a 97% rise in apixaban AUC relative to apixaban given by itself. In 18 subjects, a 10 mg oral dose of apixaban was given 4 days after starting ketoconazole 400 mg once daily 3.
b) In a drug interaction study, administering apixaban together with ketoconazole 400 mg increased apixaban Cmax and AUC by roughly 1.6-fold and 2-fold, respectively 2.
Common questions
Can I take Apixaban and Indinavir together?
Indinavir raises apixaban levels and bleeding risk, so your care team may avoid the combination, halve a higher apixaban dose, or watch you more closely. Do not change either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Indinavir 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 Indinavir interaction managed?
Good news: this is manageable with your care team. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. If you take apixaban at 2.5 mg twice daily, using it together with indinavir is generally avoided, so your team may pick an alternative. If you take 5 mg or 10 mg twice daily, your team may cut the apixaban dose in half while you are on indinavir. Expect c… 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 Indinavir 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 (3)
- Product Information: ELIQUIS(R) oral tablets, tablets for suspension, apixaban oral tablets, tablets for suspension. Bristol-Myers Squibb Company (per Manufacturer), Princeton, NJ, 2025. DailyMed
- Product Information: ELIQUIS(R) oral film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
- Frost CE, Byon W, Song Y, et al: Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79(5):838-846.
Keep reading about Indinavir
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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