Telithromycin 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
Telithromycin
No brand names on recordApixaban
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.
Taking these two together can raise the amount of apixaban (Eliquis) in your body. Apixaban is a blood thinner. The antibiotic telithromycin slows down how your body clears apixaban, so more of it can build up. That means a higher chance of bleeding, such as easy bruising, nosebleeds, bleeding gums, or blood in your urine or stool.
The good news is your care team can manage this. They may adjust your apixaban dose or watch you more closely while you are on the antibiotic. Don't stop or change either medicine on your own. Just let your pharmacist or doctor know you've been prescribed both, and call right away if you notice unusual bleeding.
Effect: Increased apixaban exposure and elevated bleeding risk. Telithromycin is a combined strong CYP3A4 and P-gp inhibitor; apixaban is a substrate of both.
- Mechanism: Reduced CYP3A4 metabolism plus reduced P-gp efflux, increasing apixaban plasma levels (PK interaction, increases drug effect). Neither drug is a prodrug.
- Magnitude: Analogous strong dual inhibitor (ketoconazole) raised apixaban Cmax ~62% and AUC ~97%.
- Evidence/onset: Probable; onset unspecified.
- Management: Avoid combination if apixaban is 2.5 mg BID. For 5 or 10 mg BID, reduce apixaban dose by 50%. Monitor for bleeding.
What happens
Increased apixaban exposure and an increased risk of bleeding
Interaction Deep Dive
For patients taking apixaban at 2.5 mg orally twice daily, coadministration should be avoided. When higher apixaban doses are involved (that is, 5 or 10 mg twice daily), reduce the dose by 50% if a combined P-gp and strong CYP3A4 inhibitor is used at the same time. Because apixaban is a substrate of both CYP3A4 and P-gp, using it together with an agent that inhibits both P-gp and strongly inhibits CYP3A4 may raise apixaban exposure and heighten the potential for bleeding12. A pharmacokinetic study demonstrated that apixaban Cmax rose by 62% and AUC rose by 97% when it was given alongside ketoconazole (a combined P-gp and strong CYP3A4 inhibitor)3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism; inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
This interaction is manageable with the right dose and monitoring. Keep taking both exactly as prescribed unless your care team tells you otherwise.
- If you take low-dose apixaban (2.5 mg twice daily), the combination is generally avoided, so your team may pick a different antibiotic or adjust your plan.
- If you take a higher dose (5 or 10 mg twice daily), your team may cut the apixaban dose by half while you are on telithromycin.
- Your team may also monitor you more closely for bleeding.
- Tell your pharmacist or prescriber that you take both, and report any unusual bruising or bleeding right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Giving apixaban together with ketoconazole produced a 62% rise in apixaban Cmax and a 97% rise in apixaban AUC relative to apixaban given by itself. In 18 subjects, a single oral 10 mg dose of apixaban was given 4 days after starting ketoconazole 400 mg once daily 3.
b) In a drug interaction study, administering apixaban together with ketoconazole 400 mg raised apixaban Cmax and AUC by roughly 1.6-fold and 2-fold, respectively 2.
Common questions
Can I take Telithromycin and Apixaban together?
Telithromycin can raise apixaban levels and bleeding risk; your care team will either avoid the combination or lower your apixaban dose and watch for bleeding, so check with them before making any changes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Telithromycin 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 Telithromycin and Apixaban interaction managed?
This interaction is manageable with the right dose and monitoring. Keep taking both exactly as prescribed unless your care team tells you otherwise. If you take low-dose apixaban (2.5 mg twice daily), the combination is generally avoided, so your team may pick a different antibiotic or adjust your plan. If you take a higher dose (5 or 10 mg twice daily), your team may cut the apixaban dose by half… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Telithromycin 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 tablets, tablets for suspension, apixaban oral tablets, tablets for suspension. Bristol-Myers Squibb Company (per Manufacturer), Princeton, NJ, 2025. DailyMed
- Product Information: ELIQUIS(R) oral film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
- Frost CE, Byon W, Song Y, et al: Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79(5):838-846.
Keep reading about Telithromycin
Keep reading about Apixaban
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