Selexipag 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
Selexipag
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.
Both of these medicines can make bleeding more likely, so taking them together adds up. Apixaban (Eliquis) is a blood thinner, and selexipag (Uptravi) can affect how your platelets stick together to form clots. When you take both, your blood may have a harder time stopping a bleed.
This does not mean you can't use them together. Many people do, safely. The key is knowing the warning signs: unusual bruising, nosebleeds that won't stop, pink or red urine, black or bloody stools, or coughing up or vomiting blood. If any of those happen, get help right away. Keep taking both as prescribed, and your care team can watch you closely and adjust things as needed.
Additive pharmacodynamic bleeding risk. Apixaban is a direct factor Xa inhibitor; selexipag (a prostacyclin IP receptor agonist) has antiplatelet-type effects on hemostasis. Neither is a prodrug issue here, so this is a PD, not PK, interaction with no change in apixaban exposure.
- Direction: increased bleeding risk (additive effect on hemostasis).
- Evidence: theoretical; severity: major.
- Management: promptly evaluate any signs/symptoms of blood loss. Discontinue apixaban if active pathologic hemorrhage occurs. A specific anti-FXa reversal agent exists; PCC, aPCC, or rFVIIa may be considered. Apixaban PD effect persists at least 24 hours after the last dose. When PCC is used, PT/INR/aPTT or anti-FXa monitoring is not useful.
What happens
Increased risk of bleeding and can cause serious, potentially fatal bleeding
Interaction Deep Dive
Using apixaban together with antiplatelet medications raises bleeding risk1. In any patient receiving both anticoagulants and antiplatelet agents concurrently, quickly assess any indications or manifestations of blood loss 2. When active pathological hemorrhage is present, stop apixaban. Counsel patients regarding the signs and symptoms of blood loss and instruct them to report these right away or present to an emergency room. Apixaban should be discontinued in patients with active pathological hemorrhage. A reversal agent for the anti-factor Xa activity of apixaban exists. Apixaban's pharmacodynamic effect is anticipated to remain for a minimum of 24 hours following the final dose. Options that may be considered include prothrombin complex concentrate (PCC), activated prothrombin complex concentrate, or recombinant factor VIIa. If PCCs are administered, it is neither useful nor recommended to monitor apixaban's anticoagulant effect via a clotting test (PT, INR, or aPTT) or anti-factor Xa (FXa) activity. Oral activated charcoal decreases apixaban absorption and consequently reduces its plasma concentration 1.
Why it happens (mechanism)
Additive effects on hemostasis
How to manage this interaction
Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Because these two can add to your bleeding risk, your care team's main job is to watch for and respond to any bleeding.
- Learn the warning signs of blood loss: easy bruising, prolonged bleeding, blood in urine or stool, black stools, coughing up or vomiting blood, severe headache, or unusual weakness.
- Report any of these right away, or go to an emergency room.
- Your team may monitor you more closely, and your doses may need to be individualized to you.
- In an emergency, apixaban can be reversed, and its blood-thinning effect can last at least 24 hours after the last dose.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
3 reports — tap to read
a) A clinical study of high-risk patients following acute coronary syndrome who were treated with aspirin or with aspirin plus clopidogrel (APPRAISE-2) was stopped early because bleeding occurred more frequently with apixaban than with placebo. Among patients on single antiplatelet therapy, the rate of ISTH major bleeding was 2.8% per year with apixaban versus 0.6% per year with placebo, and among those on dual antiplatelet therapy it was 5.9% per year with apixaban versus 2.5% per year with placebo 1.
b) In patients taking apixaban, adding aspirin raised the bleeding risk from 1.8% per year to 3.4% per year, and adding both aspirin and warfarin raised the bleeding risk from 2.7% per year to 4.6% per year in a clinical trial (ARISTOTLE); the use of dual antiplatelet therapy alongside apixaban was limited (2.3%) in this trial 1.
c) In a retrospective study, combining a direct oral anticoagulant (DOAC) with antiplatelet therapy (APT; n=78) compared with DOAC therapy by itself (n=329) did not meaningfully change the rate of major bleeding (1.3% vs 1.2%) or clinically relevant non-major bleeding (10.2% vs 6.4%) across 6 months of treatment. The patients were mainly Caucasian men with a mean age of 63.7 years. Those receiving concurrent APT had significantly higher mean body mass index (30.7 vs 28.4), higher mean CHA2DS2-VASc score (4.28 vs 3.85), and were more likely to have diabetes (26.9% vs 17.3%) than those given DOAC monotherapy. DOACs were prescribed for VTE treatment or atrial fibrillation and consisted of apixaban (58.5%), rivaroxaban (38.1%), and dabigatran (3.4%). Single antiplatelet therapy was used in 94.9% (74 patients), with aspirin 81 mg once daily being the most frequent regimen (69 patients). Additional APT regimens comprised aspirin 81 mg twice daily (3 patients), aspirin 325 mg daily (1 patient), clopidogrel 75 mg daily (1 patient), and dual APT with aspirin 81 mg and clopidogrel 75 mg daily (4 patients) 3.
Common questions
Can I take Selexipag and Apixaban together?
Apixaban and selexipag together can add up to a higher bleeding risk, so watch closely for any signs of bleeding and report them immediately. Keep taking both as prescribed and let your care team manage and monitor the combination. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Selexipag 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 Selexipag and Apixaban interaction managed?
Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Because these two can add to your bleeding risk, your care team's main job is to watch for and respond to any bleeding. Learn the warning signs of blood loss: easy bruising, prolonged bleeding, blood in urine or stool, black stools, coughing up or vomiting blood, severe headache, or unusual weakness. Report any of t… 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 Selexipag 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 film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
- Product Information: SAVAYSA(R) oral tablets, edoxaban oral tablets. Daiichi Sankyo Inc (per FDA), Basking Ridge, NJ, 2023. DailyMed
- Tinkham TT, Vazquez SR, Jones AE, et al: Direct oral anticoagulant plus antiplatelet therapy: prescribing practices and bleeding outcomes. J Thromb Thrombolysis 2020; 49(3):492-496. PubMed
Keep reading about Apixaban
Keep reading about Selexipag
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist