Apixaban and Troleandomycin: 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
Troleandomycin
No brand names on recordApixaban
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.
Here's what's going on. Apixaban (Eliquis) is a blood thinner that helps prevent dangerous clots. Your body clears it partly with a liver enzyme called CYP3A. Troleandomycin is a strong blocker of that enzyme. When the two are taken together, your body may clear apixaban more slowly, so the drug can build up.
More apixaban in your body means a higher chance of bleeding, like easy bruising, nosebleeds, or blood in the urine or stool. This is expected from how the drugs work rather than proven in studies, but it's worth taking seriously. The good news is your care team can manage this by choosing a different antibiotic or watching you more closely. Please don't stop either medicine on your own, just talk with your pharmacist or doctor.
Effect: Increased apixaban exposure (higher AUC/Cmax) with elevated bleeding risk.
Mechanism: Apixaban is a CYP3A4 substrate (neither drug is a prodrug). Troleandomycin is a strong CYP3A inhibitor, reducing apixaban clearance and increasing plasma concentrations. Apixaban is also a P-gp substrate, though troleandomycin is not a notable P-gp inhibitor.
Evidence: Theoretical; severity major. Onset unspecified.
Management:
- Manufacturer gives no specific guidance for strong CYP3A inhibitors lacking P-gp inhibition.
- Guidelines suggest avoiding concomitant use or using cautiously with close monitoring for bleeding.
- Consider an alternative antibiotic; individualize therapy.
What happens
Increased apixaban exposure
Interaction Deep Dive
When apixaban (a CYP3A substrate) is taken together with a potent CYP3A inhibitor, apixaban concentrations may rise substantially2. Although the manufacturer offers no specific recommendations regarding the coadministration of apixaban with strong CYP3A inhibitors that lack P-gp inhibitory activity 1, clinical guidelines recommend either avoiding the combination or using it with caution alongside close monitoring 2.
Why it happens (mechanism)
Inhibition of CYP3A-mediated metabolism of apixaban
How to manage this interaction
This is manageable with your care team's help. Because troleandomycin can raise apixaban levels, your prescriber may take one of a few practical steps:
- Choose a different antibiotic that doesn't affect apixaban.
- Or keep both but monitor you more closely for signs of bleeding.
- Your dose may need to be adjusted and individualized by your care team.
What you should do: Keep taking both exactly as prescribed unless told otherwise. Tell your pharmacist or doctor about this combination, and report any unusual bruising, nosebleeds, dark or bloody stools, pink or red urine, or dizziness right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Troleandomycin together?
Troleandomycin can raise apixaban (Eliquis) levels and increase bleeding risk, so your care team may pick a different antibiotic or watch you closely. Don't change anything on your own, check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Troleandomycin 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 Troleandomycin interaction managed?
This is manageable with your care team's help. Because troleandomycin can raise apixaban levels, your prescriber may take one of a few practical steps: Choose a different antibiotic that doesn't affect apixaban. Or keep both but monitor you more closely for signs of bleeding. Your dose may need to be adjusted and individualized by your care team. What you should do: Keep taking both exactly as pre… 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 Troleandomycin 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 (2)
- Product Information: ELIQUIS(R) oral film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
- 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.
Keep reading about Troleandomycin
Keep reading about Apixaban
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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