Eliquis With Fluconazole Drug Interaction
In our latest question and answer, the pharmacist discusses the interaction between Eliquis and fluconazole.
I recently was in the hospital, and they put me on Eliquis for a pulmonary embolism. I have had problems with yeast infections in the past and usually took fluconazole, but I recently found out it may not be safe with the Eliquis. Can I take them together?
Nov 14, 2022- Taking Eliquis with fluconazole increases your bleeding risk because fluconazole raises the amount of Eliquis in your body.
- If possible, talk to your doctor about using a topical antifungal medicine instead, such as an intravaginal cream for yeast infections.
- Watch for signs of bleeding like easy bruising, bleeding gums, black or tarry stools, dizziness, or paleness, and contact your doctor right away if you notice any of these.
Answer
There is a drug interaction between Eliquis (apixaban) and fluconazole that is important to be aware. Combining these medications can increase the risk of bleeding.
If there are alternatives to fluconazole available to you, they may represent a safer option. Otherwise, it is important to look out for any signs or symptoms of possible bleeding and talk to your doctor right away if they occur.
Eliquis - Fluconazole Interaction Details
As mentioned, the combination of Eliquis and fluconazole increases the risk of bleeding.
This happens because fluconazole is a strong inhibitor of the metabolizing enzyme CYP3A4, the enzyme responsible for breaking down Eliquis. Inhibition of this enzyme by fluconazole increases concentration of Eliquis in your system, which increases the risk of dose-dependent side effects.
One large scale study involving over 100,000 individuals, concluded the following:
In patients with atrial fibrillation on either apixaban [Eliquis], rivaroxaban, or dabigatran, an association between an elevated bleeding risk and use of systemic fluconazole was found among patients on apixaban [Eliquis].
The study findings were pretty significant. Those taking the drug combination had a 3.5-fold increased risk of bleeding compared to those not taking both drugs and the most common type of bleed was gastrointestinal bleeding.
How To Manage The Interaction
If possible, consider alternatives to fluconazole if you are taking Eliquis.
Oftentimes, topical antifungal therapy can be used to treat a fungal infection, and topical antifungals have not been shown to have this interaction with Eliquis.
You mentioned in your question that you use fluconazole for yeast infections. Alternatives for you could include intravaginal drugs, such as Monistat or terconazole.
If you and your doctor decide that fluconazole is the best option for you, and you take Eliquis, be sure to monitor for signs of bleeding, such as:
- Easy bruising
- Bleeding gums
- Black or tarry stool
- Feeling faint or dizzy
- Paleness
Be sure to speak with your doctor immediately if you feel you are experiencing side effects from the drug combination.
Final Words
I hope this answer helped! Reach back out anytime.
References & sources
- Bleeding Risk Following Systemic Fluconazole or Topical Azoles in Patients with Atrial Fibrillation on Apixaban, Rivaroxaban, or Dabigatran — PubMed
- Association between concurrent use of diltiazem and DOACs and risk of bleeding in atrial fibrillation patients — PubMed
- The real world use of combined P-glycoprotein and moderate CYP3A4 inhibitors with rivaroxaban or apixaban increases bleeding — PubMed
- Eliquis Prescribing Information — AccessFDA
Glossary — Terms in This Answer
- Drug interaction
- An unwanted reaction that occurs when two or more medications affect each other's effectiveness or safety when taken together.
- Eliquis
- A prescription blood thinner medication used to reduce the risk of blood clots and stroke.
- Fluconazole
- An antifungal medication used to treat fungal infections like yeast infections.
- CYP3A4
- An enzyme in your body responsible for breaking down and removing certain drugs from your system.
- Enzyme inhibitor
- A substance that slows down or blocks the action of an enzyme, preventing it from doing its normal job.
- Atrial fibrillation
- An irregular heartbeat condition where the heart's upper chambers beat chaotically instead of in a regular rhythm.
- Gastrointestinal bleeding
- Abnormal bleeding occurring in the digestive system, which may appear as black tarry stools or vomit that looks like coffee grounds.
- Topical antifungal
- A medication applied directly to the skin or affected area to treat fungal infections without entering the bloodstream.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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