Mifepristone 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
Mifepristone
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.
Let's talk about taking mifepristone (Korlym) together with apixaban (Eliquis), a blood thinner. Mifepristone slows down the body systems that normally clear apixaban out of your body. That means apixaban can build up and become stronger than intended, which raises your chance of bleeding.
Watch for signs like easy bruising, nosebleeds, blood in your urine or stool, or bleeding that won't stop. The good news is this is very manageable. Your care team can adjust your apixaban dose and keep a closer eye on you. Please don't change anything on your own, just check in with your pharmacist or doctor.
Effect: Increased apixaban exposure and elevated bleeding risk.
Mechanism: Apixaban is a substrate of both CYP3A4 and P-gp. Mifepristone inhibits CYP3A4-mediated metabolism and P-gp-mediated efflux, reducing apixaban clearance and increasing systemic exposure. (Neither drug is a prodrug here; this is a straightforward exposure increase.)
Magnitude: Reference strong dual inhibitor (ketoconazole) raised apixaban Cmax ~62% and AUC ~97%. Evidence: probable. Onset unspecified.
- Avoid concomitant use if apixaban is 2.5 mg PO BID.
- For 5 or 10 mg BID regimens, reduce apixaban dose by 50%.
- Monitor for bleeding/signs of anticoagulant excess.
What happens
Increased apixaban exposure and an increased risk of bleeding
Interaction Deep Dive
When patients are taking apixaban at a dose of 2.5 mg orally twice daily, steer clear of combined administration. For patients on higher apixaban doses (that is, 5 or 10 mg twice daily), cut the dose in half if a combined P-gp and strong CYP3A4 inhibitor is being used at the same time. Because apixaban is a substrate of both CYP3A4 and P-gp, giving it together with an agent that inhibits both P-gp and CYP3A4 strongly can raise apixaban exposure and may heighten bleeding risk12. 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
Both drugs may be used together safely when your care team tailors the plan. Keep taking both exactly as prescribed until you speak with them.
- If you take lower-dose apixaban (2.5 mg twice daily), your team will typically avoid combining it with mifepristone and may choose an alternative.
- If you take higher doses (5 or 10 mg twice daily), your dose may be reduced by half during combined use.
- Your team may monitor you more closely for bleeding.
Tell your pharmacist or prescriber about both medicines, and report any unusual bruising or bleeding promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Giving apixaban together with ketoconazole produced a 62% rise in apixaban Cmax and a 97% rise in apixaban AUC relative to apixaban given by itself. A single oral 10 mg dose of apixaban was given 4 days after the start of ketoconazole 400 mg once daily in 18 subjects 3.
b) In a drug interaction study, administering apixaban alongside ketoconazole 400 mg increased apixaban Cmax and AUC by roughly 1.6-fold and 2-fold, respectively 2.
Common questions
Can I take Mifepristone and Apixaban together?
Mifepristone can raise apixaban levels and bleeding risk; your doctor may lower the apixaban dose or pick an alternative, so check in before changing anything. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Mifepristone 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 Mifepristone and Apixaban interaction managed?
Both drugs may be used together safely when your care team tailors the plan. Keep taking both exactly as prescribed until you speak with them. If you take lower-dose apixaban (2.5 mg twice daily), your team will typically avoid combining it with mifepristone and may choose an alternative. If you take higher doses (5 or 10 mg twice daily), your dose may be reduced by half during combined use. Your… 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 Mifepristone 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 Mifepristone
Keep reading about Apixaban
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