Drug interactions
Apixaban + Milnacipran
Severity: Moderate
Apixaban and Milnacipran: 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
Milnacipran, an SNRI, may impair platelet function and add to the bleeding risk of apixaban. Clinically relevant bleeding is mainly gastrointestinal.
What this interaction means in plain words
Apixaban and Milnacipran 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; Milnacipran belongs to Central Nervous System.
Why it happens
Additive pharmacodynamic effect: SNRI-related platelet serotonin depletion plus factor Xa inhibition.
What to do
Monitor for bleeding and anemia, especially in older patients or those with prior GI bleeding. No routine dose change is needed.
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 Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Methylene blue + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide Contraindicated
Frequently asked questions
Can I take Apixaban with Milnacipran?
MediHelp rates the interaction as moderate. Apixaban and Milnacipran 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. Milnacipran, an SNRI, may impair platelet function and add to the bleeding risk of apixaban. Clinically relevant bleeding is mainly gastrointestinal.
How serious is the interaction between Apixaban and Milnacipran?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for bleeding and anemia, especially in older patients or those with prior GI bleeding. No routine dose change is needed.
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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