Piketoprofen 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
Piketoprofen
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 that helps prevent dangerous clots. Piketoprofen is an anti-inflammatory pain medicine (an NSAID). When taken together, both can make it harder for your blood to clot, so your risk of bleeding goes up compared to using either one alone.
This is based mostly on how these medicines work rather than a lot of direct studies, but bleeding is serious enough that it's worth taking seriously. Watch for things like unusual bruising, nosebleeds, pink or dark urine, black stools, or bleeding that won't stop. Please don't stop or change either medicine on your own. Your pharmacist or doctor can review this and help you manage it safely.
Effect: Additive increase in bleeding risk. Apixaban is a direct oral factor Xa inhibitor; piketoprofen is an NSAID with antiplatelet activity and GI mucosal effects. The interaction is pharmacodynamic (additive impairment of hemostasis), not a CYP/transporter PK interaction. Neither agent is a prodrug.
- Direction: Increased anticoagulant/bleeding effect
- Onset: Unspecified
- Evidence: Theoretical; severity graded major
- Management: Monitor for signs/symptoms of bleeding, check hemoglobin/hematocrit if indicated, consider GI protection. Heightened caution with neuraxial anesthesia or spinal puncture given risk of spinal/epidural hematoma. Dose and duration should be individualized by the care team.
What happens
An increased risk of bleeding
Interaction Deep Dive
When an anticoagulant is given together with an NSAID, the likelihood of major bleeding may rise compared with taking either agent by itself1234, and in patients receiving neuraxial anesthesia or undergoing spinal puncture, this combination may heighten the chance of epidural or spinal hematomas, which can lead to prolonged or permanent paralysis5. Should the two be administered together, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
If your care team has prescribed both, keep taking them as directed unless they tell you otherwise. Here is what typically helps:
- Your team may monitor you more closely for bleeding, and your dose or the NSAID choice may be adjusted and individualized to you.
- Watch for and promptly report unusual bruising, nosebleeds, blood in urine or stool, black stools, or bleeding that won't stop.
- Tell your team before any spinal procedure or epidural/spinal anesthesia, because of a rare but serious risk of a spinal blood clot.
- Ask your pharmacist before adding any over-the-counter pain reliever.
Your pharmacist or doctor can manage this safely by tailoring your treatment.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Piketoprofen and Apixaban together?
Taking Eliquis (apixaban) with the NSAID piketoprofen adds up to a higher bleeding risk, so watch for any signs of bleeding and let your pharmacist or doctor guide the combination. Don't stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Piketoprofen 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 Piketoprofen and Apixaban interaction managed?
If your care team has prescribed both, keep taking them as directed unless they tell you otherwise. Here is what typically helps: Your team may monitor you more closely for bleeding, and your dose or the NSAID choice may be adjusted and individualized to you. Watch for and promptly report unusual bruising, nosebleeds, blood in urine or stool, black stools, or bleeding that won't stop. Tell your te… 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 Piketoprofen 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 Piketoprofen
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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