Omaveloxolone 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
Omaveloxolone
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.
You've been prescribed Skyclarys (omaveloxolone) along with the blood thinner Eliquis (apixaban). Skyclarys can gently speed up how your body breaks down apixaban, which means there could be a little less apixaban in your system. In theory, that could make the blood thinner work slightly less well at preventing clots.
The good news is this is based on limited, theoretical data, and your care team can manage it. They may simply watch you a bit more closely. Please don't stop or change either medicine on your own. If you have any questions or notice new symptoms, reach out to your pharmacist or doctor.
Mechanism: Omaveloxolone is a weak CYP3A4 inducer; apixaban is a CYP3A4 (and P-gp) substrate. Induction may increase apixaban clearance, lowering AUC/Cmax and potentially reducing anticoagulant efficacy (increased thromboembolic risk).
- Direction: reduced apixaban exposure/effect
- Magnitude: not established for apixaban; midazolam AUC fell ~45% in an interaction study (probe substrate)
- Onset: unspecified
- Evidence: theoretical
Management: Neither is a prodrug. Monitor for signs of therapeutic failure (thrombotic/embolic events). Dose may need individualization; discuss risk-benefit and consider clinical monitoring or alternative anticoagulation if concern is high.
What happens
Reduced CYP3A4 substrate exposure and reduced efficacy of CYP3A4 substrate
Interaction Deep Dive
Taking omaveloxolone, which acts as a weak inducer of CYP3A4, together with CYP3A4 substrates can lower the exposure of those substrates and, as a result, may diminish their effectiveness. When a CYP3A4 substrate is given at the same time, watch for reduced efficacy of that co-administered therapy. A drug interaction study showed that coadministering omaveloxolone with midazolam (a CYP3A4 substrate) lowered the AUC of midazolam by roughly 45%1.
Why it happens (mechanism)
Induction of CYP3A4 substrate metabolism by omaveloxolone
How to manage this interaction
Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise. The concern here is theoretical, but your team can manage it easily.
- Your care team may monitor you more closely for signs the blood thinner isn't working as well as it should.
- Your dose may need to be adjusted and individualized by your care team.
- Watch for and promptly report symptoms of a possible clot, such as leg swelling or pain, chest pain, sudden shortness of breath, or trouble speaking.
- Ask your pharmacist or doctor before starting or stopping any medicine.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a drug interaction study, coadministration of omaveloxolone with midazolam reduced the AUC of midazolam (a CYP3A4 substrate) by roughly 45% 1.
Common questions
Can I take Omaveloxolone and Apixaban together?
Skyclarys may slightly lower Eliquis levels and could make it a bit less effective at preventing clots, though this is theoretical. Keep taking both as prescribed and let your care team monitor you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Omaveloxolone 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 Omaveloxolone and Apixaban interaction managed?
Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise. The concern here is theoretical, but your team can manage it easily. Your care team may monitor you more closely for signs the blood thinner isn't working as well as it should. Your dose may need to be adjusted and individualized by your care team. Watch for and promptly report symptoms of a possible clo… 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 Omaveloxolone 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: Skyclarys® oral capsules, omaveloxolone oral capsules. Biogen U.S. Corporation, Cambridge, MA, 2026. DailyMed
Keep reading about Omaveloxolone
Keep reading about Apixaban
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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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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