Drug interactions
Apixaban + Itraconazole
Severity: Major
Apixaban and Itraconazole: 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
Itraconazole substantially increases apixaban exposure, raising the risk of serious bleeding. Apixaban is a substrate of both CYP3A4 and P-glycoprotein, both strongly inhibited by itraconazole.
What this interaction means in plain words
Apixaban and Itraconazole 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; Itraconazole belongs to Anti Fungals.
Why it happens
Itraconazole inhibits CYP3A4 and P-glycoprotein, reducing apixaban clearance.
What to do
Reduce the apixaban dose by 50% if the patient takes 5 or 10 mg twice daily, and avoid the combination if already on 2.5 mg twice daily. Monitor for bleeding or consider an alternative anticoagulant or antifungal.
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 Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
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 Itraconazole?
MediHelp rates the interaction as major. Apixaban and Itraconazole 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. Itraconazole substantially increases apixaban exposure, raising the risk of serious bleeding. Apixaban is a substrate of both CYP3A4 and P-glycoprotein, both strongly inhibited by itraconazole.
How serious is the interaction between Apixaban and Itraconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the apixaban dose by 50% if the patient takes 5 or 10 mg twice daily, and avoid the combination if already on 2.5 mg twice daily. Monitor for bleeding or consider an alternative anticoagulant or antifungal.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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