Lonafarnib 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
Lonafarnib
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.
Taking these two together can raise the level of your blood thinner. Apixaban (Eliquis) is a blood thinner that helps prevent clots. Lonafarnib (Zokinvy) slows down the way your body breaks down and clears apixaban, so more of it can build up in your blood. That means a higher 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. They may adjust your apixaban dose or watch you more closely. Please don't change anything on your own, just talk with your pharmacist or doctor so they can tailor the plan to you.
Effect: Increased apixaban exposure and elevated bleeding risk.
Mechanism: Lonafarnib is a combined strong CYP3A4 and P-gp inhibitor; apixaban is a substrate of both. Dual inhibition reduces metabolism and efflux, increasing apixaban Cmax and AUC. (Neither drug is a prodrug; effect is a direct increase in anticoagulant exposure.)
Magnitude: Analogous ketoconazole data showed Cmax +62%, AUC +97%. Evidence: probable; onset unspecified.
- Avoid coadministration when apixaban is dosed 2.5 mg PO BID.
- For apixaban 5 or 10 mg BID, reduce dose by 50% during concomitant use.
- Monitor for signs of bleeding.
What happens
Increased apixaban exposure and an increased risk of bleeding
Interaction Deep Dive
When apixaban is being taken at a dose of 2.5 mg by mouth twice daily, concurrent use should be avoided. For patients on higher apixaban regimens (that is, 5 or 10 mg twice daily), reduce the dose by 50% when a combined P-gp and strong CYP3A4 inhibitor is used at the same time. Apixaban is a substrate of both CYP3A4 and P-gp, so administering it together with an agent that inhibits both P-gp and CYP3A4 strongly can raise apixaban exposure and may heighten the likelihood of bleeding12. A pharmacokinetic study demonstrated that coadministration with ketoconazole (a combined P-gp and strong CYP3A4 inhibitor) produced a 62% rise in apixaban Cmax and a 97% rise in AUC3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism; inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
This interaction is manageable with the right adjustments. Because lonafarnib can push apixaban levels higher, your care team will tailor your plan.
- If you take apixaban 2.5 mg twice daily, the combination is generally avoided, so your team may choose a different approach.
- If you take apixaban 5 mg or 10 mg twice daily, your prescriber may cut that dose by 50% while you are on both.
- Your team may also watch you more closely for bleeding.
Keep taking both exactly as prescribed, and watch for unusual bruising, nosebleeds, blood in urine or stool, or bleeding that won't stop. Contact your pharmacist or prescriber before making any changes.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) When apixaban and ketoconazole were given together, apixaban Cmax rose by 62% and apixaban AUC rose by 97% relative to apixaban given by itself. In 18 subjects, oral apixaban 10 mg was given 4 days after starting ketoconazole 400 mg once daily 3.
b) In a drug interaction study, giving apixaban together with ketoconazole 400 mg increased apixaban Cmax and AUC by roughly 1.6-fold and 2-fold, respectively 2.
Common questions
Can I take Lonafarnib and Apixaban together?
Lonafarnib raises apixaban levels and bleeding risk, so your care team may avoid the combination at low apixaban doses or cut higher doses in half and monitor you closely. Do not change your medications on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lonafarnib 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 Lonafarnib and Apixaban interaction managed?
This interaction is manageable with the right adjustments. Because lonafarnib can push apixaban levels higher, your care team will tailor your plan. If you take apixaban 2.5 mg twice daily, the combination is generally avoided, so your team may choose a different approach. If you take apixaban 5 mg or 10 mg twice daily, your prescriber may cut that dose by 50% while you are on both. Your team may… 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 Lonafarnib 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 (3)
- Product Information: ELIQUIS(R) oral tablets, tablets for suspension, apixaban oral tablets, tablets for suspension. Bristol-Myers Squibb Company (per Manufacturer), Princeton, NJ, 2025. DailyMed
- Product Information: ELIQUIS(R) oral film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
- 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.
Keep reading about Lonafarnib
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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