Fedratinib 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
Fedratinib
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.
What's going on: Fedratinib (Inrebic) slows down a liver enzyme called CYP3A4 that helps clear apixaban (Eliquis) out of your body. When that clearing slows down, more apixaban can build up in your blood.
Apixaban is a blood thinner, so higher levels can raise your chance of bruising or bleeding. The good news is your care team knows how to handle this. They may watch you a little more closely for signs of bleeding and can adjust your doses if needed. Please keep taking both medicines exactly as prescribed, and call your doctor or pharmacist right away if you notice unusual bruising, blood in your urine or stool, or bleeding that won't stop.
Mechanism: Fedratinib inhibits CYP3A4. Apixaban is partly metabolized by CYP3A4 (and is a P-gp substrate), so co-administration is expected to increase apixaban exposure (AUC/Cmax), raising bleeding risk. Fedratinib increased midazolam AUC roughly 4-fold in single-dose PK studies, indicating moderate-to-strong inhibition.
- Direction: increased apixaban effect (anticoagulant/bleeding).
- Evidence: probable; severity major.
- Onset: unspecified.
- Management: monitor for bleeding/anemia; apixaban dose may need individualized adjustment per care team. Consider CBC and clinical bleeding assessment. Weigh risk-benefit and alternatives.
What happens
Increased CYP3A4 substrate exposure
Interaction Deep Dive
Taking fedratinib (which inhibits CYP3A4) together with CYP3A4 substrates can raise the levels of those substrates and heighten the likelihood of adverse reactions associated with them. Pharmacokinetic studies using single doses showed that fedratinib produced a 4-fold rise in the AUC of midazolam (a CYP3A4 substrate). When such combined use cannot be avoided, watch for adverse reactions and modify the dosage of medications that are CYP3A4 substrates1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated substrate metabolism by fedratinib
How to manage this interaction
Keep taking both as prescribed unless your prescriber tells you otherwise. This combination can be used, but your care team will manage it carefully.
- Your team may monitor you more closely for signs of bleeding.
- Your apixaban dose may need to be adjusted and individualized by your care team.
- Watch for and report unusual bruising, nosebleeds, blood in urine or stool, black stools, or bleeding that won't stop.
Talk with your pharmacist or prescriber before starting or stopping either drug, so they can plan the right monitoring and dosing for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) Giving a single 2 mg dose of midazolam (a CYP3A4 substrate) together with fedratinib raised the midazolam AUC by 4-fold 1.
Common questions
Can I take Fedratinib and Apixaban together?
Fedratinib can raise apixaban levels and increase bleeding risk, so keep taking both as prescribed but let your care team monitor you and adjust the dose. Report any unusual bleeding or bruising right away. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Fedratinib 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 Fedratinib and Apixaban interaction managed?
Keep taking both as prescribed unless your prescriber tells you otherwise. This combination can be used, but your care team will manage it carefully. Your team may monitor you more closely for signs of bleeding. Your apixaban dose may need to be adjusted and individualized by your care team. Watch for and report unusual bruising, nosebleeds, blood in urine or stool, black stools, or bleeding that… 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 Fedratinib 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: INREBIC(R) oral capsules, fedratinib oral capsules. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2023. DailyMed
Keep reading about Fedratinib
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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