Drug interactions
Apixaban + Piroxicam
Severity: Major
Apixaban and Piroxicam: 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
Piroxicam adds to the bleeding risk of apixaban, increasing the likelihood of gastrointestinal and other bleeding. Piroxicam carries a relatively high gastrointestinal toxicity among NSAIDs, and the risk is higher in older patients.
What this interaction means in plain words
Apixaban and Piroxicam 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; Piroxicam belongs to Musculoskeletal.
Why it happens
NSAID inhibition of platelet function and gastric mucosal injury add to the anticoagulant effect of factor Xa inhibition.
What to do
Avoid piroxicam in patients on apixaban and choose paracetamol or another safer option. If an NSAID is unavoidable, use the shortest course with gastroprotection and monitor for bleeding.
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 Piroxicam
- Ketorolac intranasal + Piroxicam Contraindicated
- Ketorolac + Piroxicam Contraindicated
- Aceclofenac + Piroxicam Major
- Acemetacin + Piroxicam Major
- Acetylsalicylic acid + Piroxicam Major
- Alteplase + Piroxicam 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 Piroxicam?
MediHelp rates the interaction as major. Apixaban and Piroxicam 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. Piroxicam adds to the bleeding risk of apixaban, increasing the likelihood of gastrointestinal and other bleeding. Piroxicam carries a relatively high gastrointestinal toxicity among NSAIDs, and the risk is higher in older patients.
How serious is the interaction between Apixaban and Piroxicam?
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 piroxicam in patients on apixaban and choose paracetamol or another safer option. If an NSAID is unavoidable, use the shortest course with gastroprotection and monitor for bleeding.
What other medicines interact with Piroxicam?
MediHelp also lists interactions of Piroxicam with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Piroxicam page.
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