Sulindac 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
Sulindac
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, and sulindac (Clinoril) is an anti-inflammatory pain reliever (an NSAID). Both can make bleeding more likely, so taking them together can add up and raise your chance of bleeding, such as easy bruising, nosebleeds, or bleeding in the stomach.
The good news is that many people do use medicines like these together safely with a little extra care. Please don't stop or change either medicine on your own. Instead, talk with your pharmacist or doctor so they can decide what's best for you and watch for any signs of bleeding.
Interaction: Additive effect on hemostasis. Apixaban (direct factor Xa inhibitor) plus sulindac (NSAID with antiplatelet effect and GI mucosal injury potential) increases bleeding risk relative to either agent alone. Neither drug is a prodrug in a way that alters this direction; the effect is pharmacodynamic, not PK-based.
- Direction: Increased bleeding risk (additive).
- Evidence: Theoretical; severity rated major.
- Onset: Unspecified.
- Management: Monitor for overt/occult bleeding (GI symptoms, Hgb/Hct). Heightened vigilance for spinal/epidural hematoma with neuraxial anesthesia or spinal puncture. Consider GI protection or an alternative analgesic per clinical judgment.
What happens
An increased risk of bleeding
Interaction Deep Dive
Using an anticoagulant together with an NSAID can raise the likelihood of major bleeding compared with taking either agent by itself1234, and in patients receiving neuraxial anesthesia or undergoing spinal puncture it can elevate the risk of epidural or spinal hematomas, which may lead to prolonged or permanent paralysis5. When these medications are given together, watch for indications of bleeding124.
Why it happens (mechanism)
Additive effect on hemostasis
How to manage this interaction
Both medicines can raise bleeding risk, so your care team will manage this thoughtfully if you take them together.
- Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise.
- Your team may monitor you more closely for signs of bleeding, and your regimen can be adjusted and individualized to you.
- Watch for and report black or bloody stools, vomit that looks like coffee grounds, pink or red urine, unusual bruising, or bleeding that won't stop.
- Tell any provider before spinal anesthesia or a spinal tap, since this combo raises the risk of a spinal blood clot.
- Ask your pharmacist whether a different pain reliever might suit you better.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Sulindac and Apixaban together?
Taking Eliquis and sulindac together adds up to a higher bleeding risk, so keep both as prescribed but watch for bleeding and check with your pharmacist or doctor about whether a safer pain option fits you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sulindac 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 Sulindac and Apixaban interaction managed?
Both medicines can raise bleeding risk, so your care team will manage this thoughtfully if you take them together. Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise. Your team may monitor you more closely for signs of bleeding, and your regimen can be adjusted and individualized to you. Watch for and report black or bloody stools, vomit that looks like coffee grou… 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 Sulindac 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 Sulindac
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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