Drug interactions
Apixaban + Levomilnacipran
Severity: Moderate
Apixaban and Levomilnacipran: moderate interaction.
Last updated
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
SNRIs impair serotonin uptake into platelets, which reduces platelet aggregation. Combined with apixaban, this increases the chance of bruising and gastrointestinal or other bleeding.
What this interaction means in plain words
Apixaban and Levomilnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Apixaban belongs to Cardiovascular; Levomilnacipran belongs to Central Nervous System.
Why it happens
Pharmacodynamic additive bleeding risk from SNRI-related platelet dysfunction plus factor Xa inhibition.
What to do
Combination is acceptable when needed, with monitoring for bleeding and hemoglobin. Consider gastroprotection in patients at high GI bleeding risk.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Apixaban
- Apixaban + Dabigatran Contraindicated
- Apixaban + Defibrotide Contraindicated
- Apixaban + Edoxaban Contraindicated
- Apixaban + Ketorolac Contraindicated
- Apixaban + Mifepristone Contraindicated
- Abciximab + Apixaban Major
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Apixaban with Levomilnacipran?
MediHelp rates the interaction as moderate. Apixaban and Levomilnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. SNRIs impair serotonin uptake into platelets, which reduces platelet aggregation. Combined with apixaban, this increases the chance of bruising and gastrointestinal or other bleeding.
How serious is the interaction between Apixaban and Levomilnacipran?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Combination is acceptable when needed, with monitoring for bleeding and hemoglobin. Consider gastroprotection in patients at high GI bleeding risk.
What other medicines interact with Apixaban?
MediHelp also lists interactions of Apixaban with, for example, Dabigatran, Defibrotide, Edoxaban. The full list is on the Apixaban page.
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