Drug interactions
Apixaban + Naproxen
Severity: Major
Apixaban and Naproxen: 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
Naproxen taken with apixaban increases the risk of bleeding, including gastrointestinal haemorrhage. NSAIDs impair platelet function and injure the gastric mucosa while apixaban reduces clotting. The effect is increased bleeding, not reduced anticoagulation.
What this interaction means in plain words
Apixaban and Naproxen 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; Naproxen belongs to Musculoskeletal.
Why it happens
Additive haemostatic impairment from NSAID platelet inhibition and mucosal injury plus factor Xa inhibition.
What to do
Avoid regular NSAID use in patients on apixaban and use paracetamol where possible. If unavoidable, give the shortest course with gastroprotection and monitor for signs of bleeding and falling haemoglobin.
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 Naproxen
- Ketorolac intranasal + Naproxen Contraindicated
- Ketorolac + Naproxen Contraindicated
- Aceclofenac + Naproxen Major
- Acemetacin + Naproxen Major
- Acetylsalicylic acid + Naproxen Major
- Alteplase + Naproxen 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 Naproxen?
MediHelp rates the interaction as major. Apixaban and Naproxen 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. Naproxen taken with apixaban increases the risk of bleeding, including gastrointestinal haemorrhage. NSAIDs impair platelet function and injure the gastric mucosa while apixaban reduces clotting. The effect is increased bleeding, not reduced anticoagulation.
How serious is the interaction between Apixaban and Naproxen?
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 regular NSAID use in patients on apixaban and use paracetamol where possible. If unavoidable, give the shortest course with gastroprotection and monitor for signs of bleeding and falling haemoglobin.
What other medicines interact with Naproxen?
MediHelp also lists interactions of Naproxen with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Naproxen page.
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