Donanemab-Azbt 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
Apixaban
Donanemab-Azbt
No brand names on record
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.
Eliquis (apixaban) is a blood thinner that helps prevent dangerous clots, but it also makes bleeding more likely. Donanemab is an Alzheimer's treatment that can cause a side effect called ARIA, which includes small areas of swelling or bleeding in the brain seen on MRI scans.
When these two are used together, the concern is that the bleeding risk in the brain may add up, raising the chance of a serious bleed. This is considered a major concern, and some expert groups suggest avoiding donanemab in people on blood thinners. Please don't stop either medicine on your own. Talk with your doctor or pharmacist so they can weigh the risks and watch you closely.
Interaction: Additive bleeding risk. Apixaban (a direct factor Xa inhibitor) combined with donanemab-azbt may increase the risk of ARIA-H and intracerebral hemorrhage. Neither drug alters the other's metabolism; the mechanism is pharmacodynamic.
- Evidence: Probable. Trial data showed ARIA-H in 30% (106/349) with concomitant antithrombotics vs 29% (148/504) without; ICH greater than 1 cm in 0.6% vs 0.4%. Limited non-aspirin anticoagulant exposure restricts firm conclusions.
- Severity: Major.
- Management: Exercise caution; expert workgroups recommend against donanemab in patients on anticoagulants including apixaban. Individualize risk assessment, review baseline MRI for cerebral amyloid angiopathy, and monitor closely.
What happens
An increased risk of amyloid related imaging abnormalities (ARIA), or intracerebral hemorrhage
Interaction Deep Dive
Use care when donanemab-azbt is given together with anticoagulants, since this combination may raise the likelihood of intracerebral hemorrhage, especially in patients who require anticoagulant therapy or those whose MRI results point to cerebral amyloid angiopathy. A drug interaction study permitted baseline use of antithrombotic agents (anticoagulants). Among patients receiving donanemab-azbt along with a concomitant antithrombotic within 30 days, ARIA with hemosiderin deposition (ARIA-H) occurred in 30% (106/349), versus 29% (148/504) in those who did not receive an antithrombotic within 30 days of an ARIA-H event. Intracerebral hemorrhage exceeding 1 cm in diameter was seen in 0.6% (2/349 patients) of those taking donanemab-azbt with a concomitant antithrombotic, compared with 0.4% (2/504) among those not given an antithrombotic. Because the number of events was small and exposure to non-aspirin antithrombotic agents was limited, firm conclusions cannot be drawn regarding the risk of ARIA or intracerebral hemorrhage in patients receiving antithrombotic medications1. The Alzheimer's Disease and Related Disorders Therapeutic Workgroup advises against giving donanemab to patients on anticoagulant therapy, including warfarin, vitamin K antagonists, direct oral anticoagulants such as dabigatran, rivaroxaban, edoxaban, apixaban, or betrixaban, or heparin 2.
Why it happens (mechanism)
Additive effects on bleeding
How to manage this interaction
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. This combination needs a careful, individualized decision.
- Your care team will weigh your clotting risk against the bleeding risk before and during treatment. Some expert groups recommend against donanemab in people taking anticoagulants like apixaban.
- Your team may review your brain MRI for signs of cerebral amyloid angiopathy and monitor you more closely for ARIA.
- Tell your doctor or pharmacist about all blood thinners, and report new headaches, confusion, vision changes, dizziness, or weakness right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) The Alzheimer's Disease and Related Disorders Therapeutic Workgroup advises against administering donanemab to patients receiving anticoagulant therapy, including warfarin, vitamin K antagonists, direct oral anticoagulants such as dabigatran, rivaroxaban, edoxaban, apixaban, or betrixaban, or heparin. Using these agents together may raise the likelihood of macrohemorrhage linked to amyloid-related imaging abnormalities (ARIA). A heightened risk of macrohemorrhages was noted when anticoagulants were combined with lecanemab, a comparable medication 2.
b) In a study, safety was evaluated in patients given donanemab-azbt dosing regimen 1 (n=853) versus those given placebo (n=874), with baseline use of antithrombotic medication (anticoagulants) permitted. The rate of ARIA with hemosiderin deposition (ARIA-H) was 30% (106/349) among patients receiving donanemab-azbt together with an antithrombotic medication within 30 days, compared with 29% (148/504) among those who did not receive an antithrombotic within 30 days of an ARIA-H event. The rate of intracerebral hemorrhage larger than 1 cm in diameter was 0.6% (2/349 patients) in patients taking donanemab-azbt with a concomitant antithrombotic medication compared with 0.4% (2/504) in those who did not receive an antithrombotic. The number of events and the limited exposure to non-aspirin antithrombotic medications constrain definitive conclusions regarding the risk of ARIA or intracerebral hemorrhage in patients taking antithrombotic medications 1.
Common questions
Can I take Donanemab-Azbt and Apixaban together?
Combining apixaban with donanemab may add up bleeding risk in the brain, and some experts advise against this pairing; do not change either drug on your own and have your care team make an individualized plan with close monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Donanemab-Azbt 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 Donanemab-Azbt and Apixaban interaction managed?
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. This combination needs a careful, individualized decision. Your care team will weigh your clotting risk against the bleeding risk before and during treatment. Some expert groups recommend against donanemab in people taking anticoagulants like apixaban. Your team may review your brain MRI for signs of cerebr… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Donanemab-Azbt 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)
Keep reading about Apixaban
Keep reading about Donanemab-Azbt
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