Apixaban and Sparsentan: 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
Sparsentan
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: Apixaban (Eliquis) is a blood thinner. Your body normally pumps some of it back out using a transporter called P-gp. Sparsentan (Filspari) can slow that pump down. When the pump slows, a bit more apixaban may stay in your body, which could raise your chance of bruising or bleeding.
This concern is mostly theoretical, based on how these drugs behave rather than a lot of real-world reports, so please don't worry. Keep taking both exactly as prescribed. Just let your pharmacist or doctor know you take them together, and watch for unusual bruising, nosebleeds, or dark stools. Your care team can manage this easily.
Mechanism: Sparsentan inhibits P-glycoprotein (P-gp)-mediated efflux. Apixaban is a P-gp substrate, so co-administration may increase apixaban exposure (higher Cmax/AUC) and bleeding risk. Neither drug is a prodrug; this is a direct increase in substrate effect.
- Direction: increased apixaban exposure and anticoagulant effect
- Magnitude: not quantified for apixaban; sparsentan raised digoxin Cmax ~61% and AUC ~18%
- Onset: unspecified
- Evidence: theoretical
- Management: monitor for bleeding/bruising; dose may need individualized adjustment by the care team for sensitive/narrow-therapeutic-index P-gp substrates
What happens
Increased P-gp substrate exposure and an increased risk of P-gp substrate-related adverse effects
Interaction Deep Dive
When sparsentan, which inhibits P-gp, is taken alongside sensitive P-gp substrates, exposure to those transporter substrates can rise. Coadministration with sparsentan raised the Cmax of digoxin (a P-gp substrate) by 61% and its AUC(0-inf) by 18%. During coadministration, watch for adverse reactions and consider lowering the dose of P-gp substrates that have narrow therapeutic indices1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport by sparsentan
How to manage this interaction
Keep taking both medications as prescribed unless your prescriber tells you otherwise. Because sparsentan can raise apixaban levels, your care team may take a few simple steps.
- They may monitor you more closely for signs of bleeding or bruising.
- Your apixaban dose may need to be adjusted and individualized by your care team.
- Watch for and report unusual bruising, nosebleeds, blood in urine or stool, or dark/tarry stools.
Make sure your pharmacist and doctor know you take both drugs so they can tailor your plan.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) When administered together with sparsentan, the exposure of digoxin (a P-gp substrate) rose, with Cmax increasing by 61% and AUC(0-inf) increasing by 18% 1.
Common questions
Can I take Apixaban and Sparsentan together?
Sparsentan can raise apixaban levels by slowing P-gp, slightly increasing bleeding risk; keep taking both as prescribed, watch for bruising or bleeding, and let your care team monitor and adjust your dose as needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Sparsentan 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 Sparsentan interaction managed?
Keep taking both medications as prescribed unless your prescriber tells you otherwise. Because sparsentan can raise apixaban levels, your care team may take a few simple steps. They may monitor you more closely for signs of bleeding or bruising. Your apixaban dose may need to be adjusted and individualized by your care team. Watch for and report unusual bruising, nosebleeds, blood in urine or stoo… 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 Sparsentan 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: FILSPARI® oral tablets, sparsentan oral tablets. Travere Therapeutics Inc, San Diego, CA, 2026. DailyMed
Keep reading about Apixaban
Keep reading about Sparsentan
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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