Drug interactions
Apixaban + Indomethacin
Severity: Major
Apixaban and Indomethacin: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Indomethacin inhibits platelet function and damages the gastric mucosa, which adds to the bleeding risk of apixaban. Gastrointestinal and other clinically significant bleeding is more likely with the combination.
What this interaction means in plain words
Apixaban and Indomethacin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Apixaban belongs to Cardiovascular; Indomethacin belongs to Musculoskeletal.
Why it happens
Additive pharmacodynamic effect of NSAID antiplatelet action and mucosal injury with factor Xa inhibition.
What to do
Avoid the combination where possible and use paracetamol or another non-NSAID analgesic. If an NSAID is essential, use the shortest course, consider gastroprotection with a proton pump inhibitor and monitor for bleeding and anemia.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Indomethacin
- Indomethacin + Ketorolac Contraindicated
- Indomethacin + Ketorolac intranasal Contraindicated
- Aceclofenac + Indomethacin Major
- Acemetacin + Indomethacin Major
- Acetylsalicylic acid + Indomethacin Major
- Alteplase + Indomethacin Major
Other interactions of Apixaban
- Apixaban + Dabigatran Contraindicated
- Apixaban + Defibrotide Contraindicated
- Apixaban + Edoxaban Contraindicated
- Apixaban + Ketorolac Contraindicated
- Apixaban + Mifepristone Contraindicated
- Abciximab + Apixaban Major
Frequently asked questions
Can I take Apixaban with Indomethacin?
MediHelp rates the interaction as major. Apixaban and Indomethacin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Indomethacin inhibits platelet function and damages the gastric mucosa, which adds to the bleeding risk of apixaban. Gastrointestinal and other clinically significant bleeding is more likely with the combination.
How serious is the interaction between Apixaban and Indomethacin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and use paracetamol or another non-NSAID analgesic. If an NSAID is essential, use the shortest course, consider gastroprotection with a proton pump inhibitor and monitor for bleeding and anemia.
What other medicines interact with Indomethacin?
MediHelp also lists interactions of Indomethacin with, for example, Ketorolac, Ketorolac intranasal, Aceclofenac. The full list is on the Indomethacin page.
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