Flufenamic Acid 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
Flufenamic Acid
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.
Apixaban (Eliquis) is a blood thinner, and flufenamic acid is an anti-inflammatory painkiller (an NSAID). When you take them together, both can make bleeding more likely, so the risk adds up. NSAIDs can also irritate your stomach lining, which raises the chance of stomach bleeding on top of that.
Watch for warning signs like unusual bruising, pink or red urine, black or tarry stools, nosebleeds that won't stop, or bleeding gums. Please don't stop either medicine on your own. Your care team can absolutely manage this, sometimes by monitoring you more closely or choosing a safer pain option, so just talk with your pharmacist or doctor.
Effect: Additive bleeding risk from combining a factor Xa inhibitor (apixaban) with an NSAID (flufenamic acid). Neither is a prodrug; this is a pharmacodynamic, not pharmacokinetic, interaction.
- Mechanism: Additive effect on hemostasis (anticoagulation plus NSAID-mediated platelet inhibition and GI mucosal injury).
- Severity/evidence: Major; theoretical basis.
- Onset: Unspecified.
- Management: Monitor for signs/symptoms of bleeding, including GI bleeding and, with neuraxial anesthesia or spinal puncture, epidural/spinal hematoma. Consider GI protection or a non-NSAID analgesic. Individualize therapy.
What happens
An increased risk of bleeding
Interaction Deep Dive
When an anticoagulant is given together with an NSAID, the likelihood of serious bleeding may rise compared with taking either agent by itself1234, and there may also be a greater chance of epidural or spinal hematomas capable of causing long-lasting or permanent paralysis in patients undergoing neuraxial anesthesia or spinal puncture5. Should the two be used at the same time, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise. Because this combination adds up your bleeding risk, your team may take steps to keep you safe.
- Your team may monitor you more closely for signs of bleeding.
- They may suggest a different pain reliever or add stomach protection, decisions individualized by your care team.
- Tell them if you are having any spinal procedure or epidural, since this raises a special risk.
Call your pharmacist or doctor if you notice unusual bruising, blood in urine or stool, black stools, or bleeding that won't stop.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Flufenamic Acid and Apixaban together?
Combining apixaban with the NSAID flufenamic acid adds up your bleeding risk, so watch for bleeding signs and let your pharmacist or doctor help you manage or replace the pain medicine. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Flufenamic Acid 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 Flufenamic Acid and Apixaban interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise. Because this combination adds up your bleeding risk, your team may take steps to keep you safe. Your team may monitor you more closely for signs of bleeding. They may suggest a different pain reliever or add stomach protection, decisions individualized by your care team. Tell them if you are having any spinal procedu… 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 Flufenamic Acid 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 (5)
- Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
- Product Information: CELEBREX(R) oral capsules, celecoxib oral capsules. GD Searle LLC (per FDA), New York, NY, 2016. DailyMed
- Product Information: COUMADIN(R) oral tablets, intravenous injection powder for solution, warfarin sodium oral tablets, intravenous injection powder for solution. Bristol-Myers Squibb Company (per manufacturer), Princeton, NJ, 2015. DailyMed
- Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023. DailyMed
- Product Information: PRADAXA(R) oral capsules, dabigatran etexilate oral capsules. Boehringer Ingelheim Pharmaceuticals Inc (per FDA), Ridgefield, CT, 2023. DailyMed
Keep reading about Apixaban
Keep reading about Flufenamic Acid
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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:
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