Apixaban and Lumacaftor: 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
Lumacaftor
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.
Here's what's going on. Apixaban (Eliquis) is a blood thinner that helps prevent dangerous blood clots. Lumacaftor can speed up how fast your body breaks down and removes apixaban. That means there may be less apixaban in your system than you need, which could leave you less protected against clots.
This concern is based on how these drugs work rather than on direct studies, but it's worth taking seriously. The good news is your care team can manage it. Please don't stop or change either medicine on your own. Just talk with your pharmacist or doctor so they can look at the best option for you.
Effect: Decreased apixaban exposure (reduced anticoagulant effect, higher thromboembolic risk).
Mechanism: Lumacaftor is a strong CYP3A4 inducer and P-gp inducer. Apixaban is a substrate of both CYP3A4 and P-gp, so concurrent use induces its metabolism and efflux, lowering AUC and Cmax.
- Direction: Reduced apixaban effect (neither drug is a prodrug).
- Onset: Unspecified; enzyme/transporter induction is typically delayed (days to weeks).
- Evidence: Theoretical.
- Management: Avoid the combination. If unavoidable, consider an alternative anticoagulant; there is no validated apixaban dose adjustment for inducers, so individualize and monitor for thromboembolic signs.
What happens
Decreased apixaban exposure
Interaction Deep Dive
Because it can lower apixaban exposure 1, the simultaneous administration of apixaban (which serves as a substrate for both P-gp and CYP3A4) together with an agent that induces both P-gp and CYP3A4 strongly 1, for example lumacaftor 2, should not be undertaken.
Why it happens (mechanism)
Induction of CYP3A4-mediated apixaban metabolism; induction of P-gp mediated efflux transport of apixaban
How to manage this interaction
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. This combination is generally something clinicians try to avoid because lumacaftor can lower apixaban levels and weaken its clot-preventing effect.
- Ask your pharmacist or doctor whether a different anticoagulant might be a better fit while you are on lumacaftor.
- Your care team may monitor you more closely for signs of a clot.
- Report symptoms like leg swelling or pain, sudden shortness of breath, chest pain, or new weakness or trouble speaking right away.
Bring a full medication list to every visit so your team can tailor the plan for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Lumacaftor together?
Lumacaftor can lower apixaban levels and reduce its clot protection, so this combination is best avoided. Talk with your pharmacist or doctor about the safest anticoagulant option for you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Lumacaftor 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 Lumacaftor interaction managed?
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. This combination is generally something clinicians try to avoid because lumacaftor can lower apixaban levels and weaken its clot-preventing effect. Ask your pharmacist or doctor whether a different anticoagulant might be a better fit while you are on lumacaftor. Your care team may monitor you more closely for sign… 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 Lumacaftor 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 (2)
- Product Information: ELIQUIS(R) oral tablets, apixaban oral tablets. Bristol-Myers Squibb Company (per manufacturer), Princeton, NJ, 2021. DailyMed
- Product Information: ORKAMBI(R) oral tablets, lumacaftor ivacaftor oral tablets. Vertex Pharmaceuticals Incorporated (per manufacturer), Boston, MA, 2018. DailyMed
Keep reading about Lumacaftor
Keep reading about Apixaban
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