Apixaban and Nimesulide Beta Cyclodextrin: 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 Beta Cyclodextrin
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.
Apixaban (Eliquis) is a blood thinner, and nimesulide is an anti-inflammatory painkiller (an NSAID). Taking them together can add up and raise your chance of bleeding. That might show up as easy bruising, nosebleeds, bleeding gums, or, more rarely, more serious internal bleeding.
This warning is based on how these types of drugs work together rather than on a specific study, but bleeding is something we take seriously. The good news is your care team can manage this. Please keep taking both exactly as prescribed, and let your pharmacist or doctor know so they can watch you more closely. Call right away if you notice unusual bruising, black stools, pink urine, or bleeding that won't stop.
Effect: Additive bleeding risk when apixaban (a direct factor Xa inhibitor) is combined with nimesulide (an NSAID).
- Mechanism: Pharmacodynamic, additive impairment of hemostasis. NSAIDs also add antiplatelet effects and GI mucosal injury. Neither agent's activity depends on the other's metabolism here.
- Direction/magnitude: Increased bleeding risk versus either drug alone; magnitude not quantified.
- Evidence/onset: Theoretical; onset unspecified.
- Management: Monitor for signs/symptoms of bleeding (Hgb/Hct, GI and mucocutaneous bleeding). Elevated risk of epidural/spinal hematoma with neuraxial anesthesia or spinal puncture; assess timing carefully. Consider GI protection or an alternative analgesic per clinical judgment.
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. In patients receiving neuraxial anesthesia or undergoing spinal puncture, this combination may also heighten the chance of epidural or spinal hematomas, which can lead to long-term or permanent paralysis5. Should the two be administered together, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. The main step here is closer attention to bleeding.
- Your care team may monitor you more closely and check for signs of bleeding.
- They may consider a different pain reliever or add stomach protection, individualized to you.
- Tell any provider about this combination before spinal or epidural procedures, as this carries a higher risk of a spinal blood clot (hematoma).
- Report bruising, nosebleeds, bleeding gums, black or bloody stools, pink or red urine, or unusual headache or weakness.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Nimesulide Beta Cyclodextrin together?
Combining the blood thinner apixaban with the NSAID nimesulide adds up to a higher bleeding risk, so keep taking both as prescribed but ask your pharmacist or doctor how they'll monitor you and watch for any signs of bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Nimesulide Beta Cyclodextrin 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 Beta Cyclodextrin interaction managed?
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. The main step here is closer attention to bleeding. Your care team may monitor you more closely and check for signs of bleeding. They may consider a different pain reliever or add stomach protection, individualized to you. Tell any provider about this combination before spinal or epidural procedures, as this carri… 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 Beta Cyclodextrin 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 Beta Cyclodextrin
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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