Apixaban and Mavacamten: 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
Mavacamten
Apixaban
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: Mavacamten (Camzyos) can gently speed up the liver enzyme that helps break down apixaban (Eliquis). That means your body may clear the apixaban a little faster, so it could work slightly less well at preventing clots.
Right now this is mostly a theoretical concern based on lab and study predictions, not on proven bleeding or clotting problems. Apixaban is a blood thinner, so your care team wants it working just right. The good news: this is manageable. Keep taking both exactly as prescribed, and let your pharmacist or doctor know you're on both so they can keep an eye on how you're doing.
Mechanism: Mavacamten is a moderate CYP3A4 inducer; apixaban is a partial CYP3A4 substrate. Induction may increase apixaban clearance, lowering exposure (AUC/Cmax) and potentially reducing anticoagulant efficacy.
- Direction: reduced apixaban exposure and effect (neither drug is a prodrug).
- Magnitude: not established for apixaban; extrapolated from midazolam data (AUC down ~13% healthy subjects, predicted up to ~45% at upper therapeutic range).
- Evidence: theoretical/predicted; onset unspecified.
- Management: monitor for thromboembolic signs; individualize therapy and consider clinical assessment of anticoagulation adequacy per care team.
What happens
Reduced CYP3A4 substrate exposure and reduced efficacy of CYP3A4 substrate
Interaction Deep Dive
When mavacamten is given together with CYP3A4 substrates, exposure to those substrates may fall, potentially diminishing their effectiveness. For this reason, careful monitoring is warranted during concurrent use of mavacamten and CYP3A4 substrates. A drug interaction study in healthy subjects showed that a 16 day regimen of mavacamten (25 mg on days 1 and 2, then 15 mg for 14 days) lowered midazolam AUC(inf) by 13% and Cmax by 7%. In symptomatic obstructive hypertrophic cardiomyopathy (HCM) patients receiving once daily mavacamten at the upper end of the therapeutic range, midazolam AUC(inf) and Cmax are projected to fall by as much as 45% and 24%, respectively1.
Why it happens (mechanism)
Induction of CYP3A4-substrate metabolism by mavacamten
How to manage this interaction
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Because mavacamten may slightly lower the amount of apixaban in your body, your care team will want to make sure your blood thinner is still doing its job.
- Your team may monitor you more closely for signs that clot protection is reduced.
- Watch for symptoms like leg swelling or pain, sudden shortness of breath, or chest pain, and seek care if they occur.
- Any dosing decisions may need to be adjusted and individualized by your care team.
- Tell every prescriber and your pharmacist that you take both drugs.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a drug interaction study, giving a 16 day regimen of mavacamten (25 mg on days 1 and 2, then 15 mg for 14 days) together with midazolam reduced the AUC(inf) and Cmax of midazolam by 13% and 7%, respectively, in healthy subjects. When mavacamten is given once daily to symptomatic obstructive hypertrophic cardiomyopathy (HCM) patients at the upper end of the therapeutic range, midazolam AUC(inf) and Cmax are projected to fall by up to 45% and 24%, respectively 1.
Common questions
Can I take Apixaban and Mavacamten together?
Mavacamten may modestly speed up how fast your body clears apixaban, which could slightly weaken its clot protection; keep taking both as prescribed and let your care team monitor you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Mavacamten 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 Mavacamten interaction managed?
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Because mavacamten may slightly lower the amount of apixaban in your body, your care team will want to make sure your blood thinner is still doing its job. Your team may monitor you more closely for signs that clot protection is reduced. Watch for symptoms like leg swelling or pain, sudden shortness of breath, or… 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 Mavacamten 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: CAMZYOS(R) oral capsules, mavacamten oral capsules. Bristol-Myers Squibb Company (per Manufacturer), Princeton, NJ, 2025. DailyMed
Keep reading about Mavacamten
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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