Apixaban and Vinblastine: 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
Vinblastine
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 that helps prevent dangerous clots. Vinblastine (Velban) is a chemotherapy medicine. When taken together, vinblastine may speed up how fast your body pushes apixaban out, which can leave too little apixaban in your system. If your blood thinner is weaker than it should be, you could be at higher risk of a clot.
I want to be honest: this concern is based on theory, not strong studies. Still, because a clot is serious, please don't change anything on your own. Talk with your oncologist and pharmacist. Your care team can pick the safest plan and keep a close eye on you.
Effect: Reduced apixaban exposure via possible P-gp induction by vinblastine, increasing efflux of apixaban (a P-gp substrate). Neither agent is affected by prodrug considerations; apixaban is active as given, so lower exposure means diminished anticoagulant effect and potential thromboembolic risk.
- Direction: Decreased apixaban AUC/Cmax, reduced efficacy
- Onset: Unspecified
- Evidence: Theoretical; vinblastine is only a possible P-gp inducer
- Severity: Major; database advises avoiding coadministration
- Management: Avoid combination where feasible; if used, individualize therapy and monitor closely for thromboembolic signs. Involve oncology and pharmacy in anticoagulation decisions.
What happens
Reduced apixaban exposure
Interaction Deep Dive
Because apixaban is a P-gp substrate and vinBLAStine acts as a potential P-gp inducer, taking them together may result in lower apixaban concentrations; for this reason, using them at the same time should be avoided1.
Why it happens (mechanism)
Induction of P-gp mediated efflux transport of apixaban
How to manage this interaction
The interaction data recommends avoiding this combination when possible, because vinblastine may lower apixaban levels and weaken its clot protection.
- Keep taking both exactly as prescribed unless your care team tells you otherwise. Do not stop or adjust anything yourself.
- Ask your oncologist and pharmacist whether an alternative anticoagulant is a better fit during chemotherapy.
- Your dose and plan may be adjusted and individualized by your team, and they may monitor you more closely for signs of a clot.
- Report symptoms like leg swelling or pain, chest pain, shortness of breath, or sudden weakness right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Vinblastine together?
Vinblastine may lower apixaban levels and reduce its clot protection, so guidance is to avoid the combination when possible; talk with your oncologist and pharmacist about the safest anticoagulation plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Vinblastine 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 Vinblastine interaction managed?
The interaction data recommends avoiding this combination when possible, because vinblastine may lower apixaban levels and weaken its clot protection. Keep taking both exactly as prescribed unless your care team tells you otherwise. Do not stop or adjust anything yourself. Ask your oncologist and pharmacist whether an alternative anticoagulant is a better fit during chemotherapy. Your dose and pla… 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 Vinblastine 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 (1)
- 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 Apixaban
Keep reading about Vinblastine
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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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