Apixaban and Tolmetin: 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
Tolmetin
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 tolmetin is an anti-inflammatory pain reliever (an NSAID). Taken together, both can make it harder for your blood to clot. That means the chance of bleeding, such as easy bruising, stomach bleeding, or bleeding that is hard to stop, can go up when you use them at the same time.
This does not mean you can't take both, but it is something your care team likes to keep an eye on. Please don't stop either medicine on your own. Talk with your pharmacist or doctor so they can decide the safest plan for you and tell you which warning signs to watch for.
Effect: Additive increased bleeding risk with concomitant apixaban (factor Xa inhibitor) and tolmetin (NSAID). Neither is a prodrug; this is a pharmacodynamic, not pharmacokinetic, interaction.
- Mechanism: Additive impairment of hemostasis; NSAIDs also add GI mucosal injury and platelet effects.
- Direction/magnitude: Increased bleeding vs either agent alone; magnitude not quantified.
- Evidence/onset: Theoretical; onset unspecified.
- Management: Monitor for overt/occult bleeding (GI, drop in Hgb). Heightened caution with neuraxial anesthesia or spinal puncture given spinal/epidural hematoma risk. Consider GI protection or a non-NSAID analgesic where appropriate.
What happens
An increased risk of bleeding
Interaction Deep Dive
Taking an anticoagulant together with an NSAID can raise the likelihood of serious bleeding compared with taking either agent by itself1234, and it may also heighten the chance of epidural or spinal hematomas capable of causing long-term or permanent paralysis in patients undergoing neuraxial anesthesia or spinal puncture5. When the two are given together, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
Your care team can manage this safely. Typically they will:
- Watch more closely for signs of bleeding while you take both drugs.
- Consider whether a different pain reliever (one that is not an NSAID) might work for you, or add stomach protection.
- Take extra care if you are having spinal or epidural procedures, since the bleeding risk there is higher.
Keep taking both medicines as prescribed unless your doctor tells you otherwise. Call your pharmacist or doctor right away if you notice black or bloody stools, pink or red urine, vomit that looks like coffee grounds, unusual bruising, or bleeding that won't stop.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Tolmetin together?
Combining apixaban (Eliquis) and tolmetin raises your bleeding risk, so watch for bleeding signs and check with your pharmacist or doctor before making any changes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Tolmetin 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 Tolmetin interaction managed?
Your care team can manage this safely. Typically they will: Watch more closely for signs of bleeding while you take both drugs. Consider whether a different pain reliever (one that is not an NSAID) might work for you, or add stomach protection. Take extra care if you are having spinal or epidural procedures, since the bleeding risk there is higher. Keep taking both medicines as prescribed unless y… 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 Tolmetin 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 Tolmetin
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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