Apixaban and Levomilnacipran: 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
Levomilnacipran
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.
You're taking two medicines that can each affect bleeding. Apixaban (Eliquis) is a blood thinner that helps prevent clots. Levomilnacipran is an antidepressant, and medicines in its family can make platelets (the cells that help your blood clot) a little less effective. Put them together and there may be a somewhat higher chance of bleeding, such as easy bruising, nosebleeds, or bleeding that takes longer to stop.
This is more of a caution than a sure thing, and many people take combinations like this safely. Please don't stop either medicine on your own. Your care team can watch for any signs of bleeding and keep you safe.
Effect: Additive bleeding risk when levomilnacipran (an SNRI) is combined with apixaban.
Mechanism: Pharmacodynamic (additive), not pharmacokinetic. Serotonergic agents impair serotonin-mediated platelet aggregation; apixaban is a direct factor Xa inhibitor. Neither is a prodrug and there is no relevant enzyme/transporter interaction here.
- Direction: Increased bleeding risk (additive hemostatic effect)
- Magnitude: Not quantified
- Onset: Unspecified
- Evidence: Theoretical
- Management: Use with caution; monitor for signs/symptoms of bleeding, particularly when starting or stopping levomilnacipran. Dose need not change routinely but should be individualized by the care team.
What happens
An increased risk of bleeding
Interaction Deep Dive
The likelihood of bleeding can be heightened by levomilnacipran, particularly when it is combined with warfarin or other anticoagulant agents. A possible mechanism is the influence of levomilnacipran on how platelets release serotonin. When levomilnacipran is given together with anticoagulants, exercise caution, and watch patients on anticoagulants carefully for bleeding whenever levomilnacipran treatment is initiated or stopped1.
Why it happens (mechanism)
Additive effects on hemostasis
How to manage this interaction
Good news: this is usually manageable, and both medicines are often prescribed together when needed.
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Watch for signs of bleeding: unusual bruising, nosebleeds, bleeding gums, blood in urine or stool, or cuts that won't stop.
- Be extra alert when starting or stopping the levomilnacipran, since that is when risk can shift.
- Your care team may monitor you more closely, and any dose can be adjusted and individualized by them if needed.
Tell your pharmacist or doctor right away if you notice new or unusual bleeding.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Levomilnacipran together?
Combining levomilnacipran with apixaban may modestly raise bleeding risk, so watch for unusual bruising or bleeding and keep both medicines as prescribed. Contact your pharmacist or doctor if any bleeding shows up, especially when starting or stopping the antidepressant. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Levomilnacipran 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 Levomilnacipran interaction managed?
Good news: this is usually manageable, and both medicines are often prescribed together when needed. Keep taking both as prescribed unless your prescriber tells you otherwise. Watch for signs of bleeding: unusual bruising, nosebleeds, bleeding gums, blood in urine or stool, or cuts that won't stop. Be extra alert when starting or stopping the levomilnacipran, since that is when risk can shift. 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 Levomilnacipran 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: FETZIMA(R) oral extended-release capsules, levomilnacipran oral extended-release capsules. AbbVie Inc (per FDA), North Chicago, IL, 2023. DailyMed
Keep reading about Levomilnacipran
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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