Piroxicam 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
Piroxicam
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.
Eliquis (apixaban) is a blood thinner, and Feldene (piroxicam) is an anti-inflammatory pain reliever (an NSAID). On their own, each one can raise your chance of bleeding. When you take them together, that risk adds up, so you may bruise or bleed more easily.
Watch for warning signs like unusual bruising, pink or red urine, black or tarry stools, or bleeding that won't stop. This is manageable. Your care team can watch you more closely and decide the safest plan for you. Please don't stop either medicine on your own talk with your pharmacist or doctor first if you have concerns.
Effect: Additive bleeding risk from concurrent apixaban (factor Xa inhibitor) and piroxicam (NSAID). Neither is a prodrug here; the interaction is pharmacodynamic, not metabolic.
- Mechanism: Additive impairment of hemostasis (anticoagulation plus NSAID effects on platelet function and GI mucosa).
- Evidence: Theoretical, but severity rated major given serious bleeding potential.
- Onset: Unspecified.
- Management: Monitor for signs/symptoms of bleeding (GI, mucocutaneous, hematuria). Heightened caution with neuraxial anesthesia or spinal puncture given risk of epidural/spinal hematoma. Individualize therapy; consider gastroprotection or non-NSAID analgesic alternatives.
What happens
An increased risk of bleeding
Interaction Deep Dive
Taking an anticoagulant together with an NSAID can raise the likelihood of significant bleeding compared with either agent given by itself1234, and it can also heighten the chance of epidural or spinal hematomas capable of causing prolonged or permanent paralysis in patients undergoing neuraxial anesthesia or spinal puncture5. When these drugs are given together, watch for signs of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
If your prescriber has you on both, keep taking them as directed unless told otherwise. Your care team can manage this by monitoring you more closely and tailoring your plan.
- Watch for and report signs of bleeding: unusual bruising, nosebleeds, pink/red urine, black or tarry stools, or vomiting that looks like coffee grounds.
- Tell any provider you see (especially before surgery, an epidural, or a spinal procedure) that you take both an anticoagulant and an NSAID.
- Ask your pharmacist whether a different pain reliever, like acetaminophen, might suit you.
- Do not start or stop either drug on your own; raise any concerns with your pharmacist or doctor.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Piroxicam and Apixaban together?
Taking Eliquis (apixaban) with Feldene (piroxicam) adds up your bleeding risk, so watch for bleeding signs and ask your pharmacist or doctor whether a safer pain option fits you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Piroxicam 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 Piroxicam and Apixaban interaction managed?
If your prescriber has you on both, keep taking them as directed unless told otherwise. Your care team can manage this by monitoring you more closely and tailoring your plan. Watch for and report signs of bleeding: unusual bruising, nosebleeds, pink/red urine, black or tarry stools, or vomiting that looks like coffee grounds. Tell any provider you see (especially before surgery, an epidural, or a… 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 Piroxicam 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 Piroxicam
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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