Avacopan and Apixaban: 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
Avacopan
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.
Here's what's going on. Avacopan (Tavneos) can slow down one of the liver enzymes (called CYP3A4) that helps your body break down apixaban (Eliquis). When that enzyme is slowed, more apixaban can build up in your blood than usual. Since apixaban is a blood thinner, higher levels could raise your chance of bruising or bleeding.
The good news: this is a possible, theory-based concern, not something proven to happen with these two drugs specifically. Your care team can manage it easily by tailoring your dose and keeping an eye on you. Keep taking both as prescribed, and let your pharmacist or doctor know if you notice unusual bruising or bleeding.
Mechanism: Avacopan is a moderate CYP3A4 inhibitor. Apixaban is partly a CYP3A4 substrate (also P-gp), so inhibition may reduce its clearance and increase exposure (AUC/Cmax), raising bleeding risk. Neither agent is a prodrug, so the direction is a true increase in apixaban effect.
- Direction: increased apixaban exposure and anticoagulant effect
- Magnitude: not quantified for apixaban; avacopan raised simvastatin AUC ~3.5-fold and midazolam AUC ~1.55-fold
- Evidence: theoretical (extrapolated from other CYP3A4 substrates)
- Onset: unspecified
- Management: consider CYP3A4 substrate dose individualization; monitor for signs of bleeding
What happens
Increased CYP3A4 substrate exposure
Interaction Deep Dive
Taking avacopan alongside a CYP3A4 substrate can raise the exposure to that substrate. When simvastatin, a CYP3A4 substrate, was given together with avacopan at 60 mg once daily for 7 days following food, the AUC and Cmax of simvastatin rose by 3.53-fold and 3.20-fold, respectively. Likewise, administering midazolam, a CYP3A4 substrate, with avacopan at 30 mg once daily for 11 days on an empty stomach produced increases in the AUC and Cmax of simvastatin of 1.55-fold and 1.81-fold, respectively. A reduction in the dose of CYP3A4 substrates should be considered when they are given concurrently with avacopan1.
Why it happens (mechanism)
Inhibition of CYP3A4-substrate metabolism by avacopan
How to manage this interaction
This is manageable. Keep taking both avacopan and apixaban exactly as prescribed unless your care team tells you otherwise.
- Your apixaban dose may need to be adjusted and individualized by your care team while you are on avacopan.
- Your team may monitor you more closely for signs of bleeding.
- Watch for and report unusual bruising, nosebleeds, pink or red urine, black or bloody stools, or bleeding that will not stop.
- Before starting or stopping either drug, check with your pharmacist or prescriber so they can plan any dose changes.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) When simvastatin (a CYP3A4 substrate) was given together with avacopan at 60 mg daily for 7 days after food, the AUC and Cmax of simvastatin rose by 3.53-fold and 3.20-fold respectively 1.
b) When midazolam (a CYP3A4 substrate) was given together with avacopan at 30 mg daily for 11 days on an empty stomach, the AUC and Cmax of simvastatin rose by 1.55-fold and 1.81-fold respectively 1.
Common questions
Can I take Avacopan and Apixaban together?
Avacopan may raise apixaban levels and bleeding risk by slowing its breakdown, so let your care team adjust the dose and monitor you, and report any unusual bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Avacopan and Apixaban 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 Avacopan and Apixaban interaction managed?
This is manageable. Keep taking both avacopan and apixaban exactly as prescribed unless your care team tells you otherwise. Your apixaban dose may need to be adjusted and individualized by your care team while you are on avacopan. Your team may monitor you more closely for signs of bleeding. Watch for and report unusual bruising, nosebleeds, pink or red urine, black or bloody stools, or bleeding t… 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 Avacopan or Apixaban 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)
- Product Information: TAVNEOS(R) oral capsules, avacopan oral capsules. ChemoCentryx Inc (per FDA), Thousand Oaks, CA, 2024. DailyMed
Keep reading about Avacopan
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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