Apixaban and Lomitapide: 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
Lomitapide
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.
What's going on: Lomitapide can slow down a natural "pump" in your body (called P-gp) that helps move apixaban (Eliquis) out of your system. When that pump is slowed, more apixaban can build up in your blood.
Apixaban is a blood thinner, so higher levels could mean a slightly higher chance of bruising or bleeding. The good news is this is a theoretical concern, not something proven to happen every time. Your care team can manage it easily by adjusting your dose if needed and keeping a closer eye on you. Keep taking both exactly as prescribed, and let your pharmacist or doctor know if you notice unusual bruising or bleeding.
Mechanism: Lomitapide inhibits intestinal P-glycoprotein (P-gp)-mediated efflux. Apixaban is a P-gp substrate, so co-administration may increase apixaban exposure (AUC/Cmax), raising bleeding risk. Neither agent's active form depends on this transport, so effect is straightforwardly additive to anticoagulation.
- Direction: increased apixaban exposure / effect
- Magnitude: not quantified
- Onset: unspecified
- Evidence: theoretical
Management: Consider apixaban dose reduction with concomitant lomitapide; individualize per renal function, age, and weight. Monitor for signs of bleeding. No routine level exists for apixaban, so clinical monitoring is key.
What happens
Increased P-gp substrate exposure
Interaction Deep Dive
When lomitapide is given together with substrates of P-gp, the exposure to those P-gp substrates may rise. A reduction in the dose of the P-gp substrate should be considered during concurrent use with lomitapide1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport by lomitapide
How to manage this interaction
How your team typically handles this:
- They may reduce your apixaban (Eliquis) dose while you are also taking lomitapide.
- They may monitor you more closely for any signs of bleeding.
- The right dose is individualized by your care team based on your overall situation.
What you should do:
- Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise.
- Tell your pharmacist or doctor before starting these together so they can plan any dose adjustment.
- Report unusual bruising, nosebleeds, blood in urine or stool, or bleeding that won't stop.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Lomitapide together?
Lomitapide can raise apixaban levels and slightly increase bleeding risk, so your care team may lower your apixaban dose and watch you more closely. Keep taking both as prescribed and report any unusual bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Lomitapide interaction?
It is rated moderate. Can be significant — usually manageable with 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 Lomitapide interaction managed?
How your team typically handles this: They may reduce your apixaban (Eliquis) dose while you are also taking lomitapide. They may monitor you more closely for any signs of bleeding. The right dose is individualized by your care team based on your overall situation. What you should do: Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise. Tell your pharmacis… 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 Lomitapide 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 anything you'd monitor while I'm on both?
References (1)
- Product Information: JUXTAPID® oral capsules, lomitapide oral capsules. Chiesi USA, Inc. (per Manufacturer), Cary, NC, 2026. DailyMed
Keep reading about Lomitapide
Keep reading about Apixaban
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