Darunavir 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
Darunavir
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.
Darunavir (an HIV medicine, usually given with ritonavir) can slow down how your body clears apixaban (Eliquis), a blood thinner. When apixaban builds up, its blood-thinning effect gets stronger, which raises your chance of bleeding, such as easy bruising, nosebleeds, or bleeding that is hard to stop.
The good news is your care team can manage this. Depending on your apixaban dose, they may lower it or choose a different plan. Please don't change anything on your own. Keep taking both as prescribed, and check with your pharmacist or doctor so they can tailor your dose and watch you more closely.
Effect: Darunavir (typically boosted with ritonavir) inhibits both P-gp efflux and CYP3A4 metabolism of apixaban, increasing apixaban exposure (AUC/Cmax) and bleeding risk. Apixaban is the affected substrate; neither drug is a prodrug here.
Severity: Major. Onset: unspecified. Evidence: theoretical.
Management (combined P-gp + strong CYP3A4 inhibitor):
- Apixaban 5 mg or 10 mg BID: reduce apixaban dose by 50%.
- Apixaban 2.5 mg BID: avoid coadministration.
- Monitor for signs/symptoms of bleeding.
What happens
Increased apixaban exposure and an increased risk of bleeding
Interaction Deep Dive
When darunavir is given together with the oral anticoagulant apixaban, apixaban plasma concentrations may rise, which in turn raises the likelihood of bleeding events. The dosing guidance for using apixaban alongside darunavir/ritonavir is determined by the apixaban dose2. In patients taking apixaban 5 mg or 10 mg twice daily, the apixaban dose should be reduced by 50% when it is combined with agents that act as both P-gp and strong CYP3A4 inhibitors. In patients taking apixaban at 2.5 mg twice daily, concurrent use with combined P-gp and strong CYP3A4 inhibitors should be avoided 1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of apixaban; inhibition of CYP3A-mediated metabolism of apixaban
How to manage this interaction
Keep taking both medicines exactly as prescribed until your care team reviews them. Because darunavir raises apixaban levels, your dose may need to be adjusted and individualized by your team.
- If you take apixaban 5 mg or 10 mg twice daily, your prescriber may reduce the apixaban dose by half.
- If you take apixaban 2.5 mg twice daily, your team may avoid combining these and consider another option.
- Watch for and report unusual bruising, nosebleeds, blood in urine or stool, or bleeding that won't stop.
Ask your pharmacist or doctor to confirm the right plan for your specific dose.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Darunavir and Apixaban together?
Darunavir can raise apixaban levels and increase bleeding risk, so your care team may cut the apixaban dose in half or, at the 2.5 mg dose, avoid the combination. Do not change anything yourself, and report any unusual bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Darunavir 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 Darunavir and Apixaban interaction managed?
Keep taking both medicines exactly as prescribed until your care team reviews them. Because darunavir raises apixaban levels, your dose may need to be adjusted and individualized by your team. If you take apixaban 5 mg or 10 mg twice daily, your prescriber may reduce the apixaban dose by half. If you take apixaban 2.5 mg twice daily, your team may avoid combining these and consider another option.… 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 Darunavir 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 (2)
- Product Information: ELIQUIS(R) oral tablets, apixaban oral tablets. Bristol-Myers Squibb Company (per manufacturer), Princeton, NJ, 2021. DailyMed
- Product Information: PREZISTA(R) oral suspension, oral tablets, darunavir oral suspension, oral tablets. Janssen Products, LP (per FDA), Horsham, PA, 2023. DailyMed
Keep reading about Darunavir
Keep reading about Apixaban
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