Lenacapavir Injection and Apixaban: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Apixaban
Lenacapavir Injection
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 happens
Increased apixaban exposure and increased risk of bleeding
Interaction Deep Dive
Concurrent use of apixaban, a substrate of both P-gp and CYP3A45, with a dual P-gp and moderate CYP3A4 inhibitor may lead to increased apixaban serum concentrations 2 and an increased risk of bleeding 3. If concomitant use is required, use with caution 14.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated apixaban metabolism; inhibition of P-gp-mediated efflux transport of apixaban
Literature reports
1 report — tap to read
a) Treatment with a combined P-gp and moderate CYP3A4 inhibitor significantly increased risk of bleeding in patients taking apixaban or rivaroxaban for atrial fibrillation in a retrospective observational analysis (N=426). Bleeding, defined as the composite of major, clinically relevant non-major, and minor bleeding, occurred in 26.4% of the interacting agent group vs 18.4% in the propensity-matched control group (HR, 1.8; 95% CI, 1.19 to 2.73). Interacting agents consisted of diltiazem (68.1%), amiodarone (26.8%), verapamil (5.7%), dronedarone (2.3%), and multiple agents (2.8%); no patients received concomitant erythromycin. No significant differences in bleeding rates were identified when individual drug interactions were evaluated, and the impact of renal dysfunction, specific inhibitor, or specific anticoagulant were not evaluated 3.
Common questions
Can I take Lenacapavir Injection and Apixaban together?
Increased apixaban exposure and increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lenacapavir Injection 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 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 Lenacapavir Injection 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)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
- Frost CE, Byon W, Song Y, et al: Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79(5):838-846.
- Hanigan S, Das J, Pogue K, et al: The real world use of combined P-glycoprotein and moderate CYP3A4 inhibitors with rivaroxaban or apixaban increases bleeding. J Thromb Thrombolysis 2020; 49(4):636-643. PubMed
- Burnett AE, Mahan CE, Vazquez SR, et al: Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis 2016; 41(1):206-232. DOI
- Product Information: ELIQUIS(R) oral tablets, apixaban oral tablets. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2019. DailyMed
Keep reading about Apixaban
Keep reading about Lenacapavir Injection
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