Apixaban and Nimesulide: 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
Apixaban
Nimesulide
No brand names on record
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 risk of bleeding. Apixaban (Eliquis) is a blood thinner, and nimesulide is an anti-inflammatory painkiller (an NSAID). Each one, on its own, can make bleeding more likely. NSAIDs can also irritate the stomach lining, which adds to the concern. Together, their effects can add up, so bruising, nosebleeds, or stomach bleeding may happen more easily.
The good news is that your care team can manage this. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, and watch for warning signs like unusual bruising, black or bloody stools, pink or red urine, or bleeding that won't stop.
Additive bleeding risk (pharmacodynamic interaction). Apixaban is a direct factor Xa inhibitor; nimesulide is an NSAID with antiplatelet and GI-mucosal effects. Neither is a prodrug here, so the concern is additive impairment of hemostasis rather than a PK change.
- Direction: increased bleeding risk versus either agent alone.
- Evidence: theoretical; severity graded major.
- Special caution: risk of epidural/spinal hematoma with neuraxial anesthesia or spinal puncture.
- Management: if used concomitantly, monitor for bleeding (CBC/Hgb, GI symptoms, bruising). Consider gastroprotection and reassess NSAID necessity or alternatives per the care team.
What happens
An increased risk of bleeding
Interaction Deep Dive
When an anticoagulant is given together with an NSAID, the likelihood of serious bleeding may rise compared with taking either agent by itself1234, and there may also be a heightened chance of epidural or spinal hematomas capable of causing prolonged or permanent paralysis in individuals receiving neuraxial anesthesia or undergoing spinal puncture 5. Should the two be taken at the same time, watch for indications of bleeding 124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
This can be managed with awareness and monitoring. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your care team may monitor you more closely for signs of bleeding and check bloodwork.
- They may consider whether a different pain option is a better fit, or add stomach protection, individualized to you.
- Tell them right away about black or bloody stools, vomit that looks like coffee grounds, red or pink urine, severe headache, unusual bruising, or bleeding that won't stop.
- If you have any spinal procedure or epidural planned, make sure that team knows you take both.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Nimesulide together?
Combining apixaban (a blood thinner) with nimesulide (an NSAID) adds up to a higher bleeding risk, so keep taking both as prescribed but check with your pharmacist or doctor and watch closely for any signs of bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Nimesulide 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 Nimesulide interaction managed?
This can be managed with awareness and monitoring. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your care team may monitor you more closely for signs of bleeding and check bloodwork. They may consider whether a different pain option is a better fit, or add stomach protection, individualized to you. Tell them right away about black or bloody stools, v… 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 Nimesulide 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 (5)
- Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
- Product Information: CELEBREX(R) oral capsules, celecoxib oral capsules. GD Searle LLC (per FDA), New York, NY, 2016. DailyMed
- Product Information: COUMADIN(R) oral tablets, intravenous injection powder for solution, warfarin sodium oral tablets, intravenous injection powder for solution. Bristol-Myers Squibb Company (per manufacturer), Princeton, NJ, 2015. DailyMed
- Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023. DailyMed
- Product Information: PRADAXA(R) oral capsules, dabigatran etexilate oral capsules. Boehringer Ingelheim Pharmaceuticals Inc (per FDA), Ridgefield, CT, 2023. DailyMed
Keep reading about Apixaban
Keep reading about Nimesulide
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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