Apixaban and Prednisone: 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
Prednisone
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.
You've been prescribed Eliquis (apixaban), a blood thinner, along with prednisone, a steroid. When these are taken together, there can be a higher chance of bleeding, especially in the stomach or gut. Prednisone can be a bit hard on the stomach lining, and apixaban slows how your blood clots, so the two together can add up.
This doesn't mean you can't take both. Many people do safely. Just watch for warning signs like black or bloody stools, vomiting that looks like coffee grounds, or unusual bruising. Let your pharmacist or doctor know if you notice anything. Your care team can manage this by keeping a closer eye on you.
Effect: Increased risk of bleeding, particularly GI bleeding, with concomitant apixaban and oral glucocorticoid.
- Direction: Additive/pharmacodynamic bleeding risk (apixaban is a direct factor Xa inhibitor; prednisone can impair GI mucosal integrity). Neither is enzyme-dependent for this effect; precise mechanism unspecified.
- Magnitude: Cohort data showed higher GIB rates with NOAC plus oral glucocorticoid; risk rose with higher glucocorticoid dose and baseline bleeding propensity.
- Evidence: Probable. Onset: Unspecified.
- Management: If coadministration is necessary, monitor closely for bleeding, especially at higher steroid doses and in high-risk patients.
What happens
Increased risk of gastrointestinal bleeding
Interaction Deep Dive
Taking apixaban together with an oral glucocorticoid can raise the likelihood of bleeding1, such as gastrointestinal bleeding (GIB). One cohort study found that patients who received non-vitamin K oral anticoagulants (NOACs) along with oral glucocorticoids within the previous 60 days had a greater incidence of GIB than patients who had not been given glucocorticoids; the risk rose with higher glucocorticoid doses and among individuals more prone to bleeding 2. When these agents must be given together, careful monitoring is advised 21.
Why it happens (mechanism)
Precise mechanism unknown
How to manage this interaction
Keep taking both medications exactly as prescribed unless your care team tells you otherwise. This combination is used when needed, and it can be managed with closer monitoring.
- Your team may watch you more closely for bleeding, especially with higher prednisone doses or if you already have a higher bleeding risk.
- Watch for and promptly report black or tarry stools, blood in stool, vomit that looks like coffee grounds, unusual bruising, or bleeding that won't stop.
- Tell your pharmacist or prescriber if your prednisone dose changes.
- Ask before adding NSAIDs (like ibuprofen) or aspirin, which can add to bleeding risk.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a nested case-control study drawn from a large cohort of Danish adults with atrial fibrillation (N=98,376; median age 75 years; 44% female; 16% exposed to glucocorticoids; 35% receiving apixaban), the combined use of non-vitamin K oral anticoagulants (NOACs) and oral glucocorticoids was linked to a higher risk of gastrointestinal bleeding (GIB) than NOACs used alone. Among patients prescribed oral glucocorticoids at an equipotent dosage below 20 mg of daily predniSOLONE during the previous 60 days (n=727), GIB was seen in 25% compared with 16% in the unexposed control group (n=28,363) [HR, 1.54; 95% CI, 1.29 to 1.84]. Relative to no exposure, this risk rose further when an equipotent dosage of 20 mg predniSOLONE or more per day was prescribed (n=536), with 32% of this group experiencing GIB [HR, 2.19; 95% CI, 1.81 to 2.65]. Most glucocorticoid prescriptions were for oral predniSOLONE (84.5%), and inflammatory lung disease was the most frequent indication (30.8%). Additional indications comprised rheumatic disease (8.4%) and cancer (8.1%); nevertheless, a non-specific or unknown indication for glucocorticoids was noted in 52.6% of the exposed group. Individuals in the exposure group had a documented prescription for any glucocorticoid within the 60 days before GIB, but specific details about the duration of glucocorticoid therapy and the timing of treatment relative to the GIB hospitalization were not reported 2.
Common questions
Can I take Apixaban and Prednisone together?
Taking prednisone with apixaban can raise your risk of stomach and gut bleeding, so keep taking both as prescribed but watch for signs of bleeding and report them to your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Prednisone 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 Prednisone interaction managed?
Keep taking both medications exactly as prescribed unless your care team tells you otherwise. This combination is used when needed, and it can be managed with closer monitoring. Your team may watch you more closely for bleeding, especially with higher prednisone doses or if you already have a higher bleeding risk. Watch for and promptly report black or tarry stools, blood in stool, vomit that look… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
- Does Prednisone Stop Cough or Clear Mucus?
- Concerns Taking Prednisone With Other Drugs For Ménière's Disease
- Prednisone With Flexeril - Interaction Details
- Can You Take Baobab Fiber With Eliquis (Apixaban)?
- Can You Replace an Evening Apixaban Dose With Berberine?
- Can I Take Ginkgo With Apixaban (Eliquis) and Atorvastatin?
Questions for your pharmacist
- Does my dose of Apixaban or Prednisone 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 (2)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
- Holt A, Blanche P, Zareini B, et al: Gastrointestinal bleeding risk following concomitant treatment with oral glucocorticoids in patients on non-vitamin K oral anticoagulants. Heart 2022; 108(8):626-632. PubMed
Keep reading about Prednisone
Keep reading about Apixaban
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