Drug interactions
Apixaban + Sulindac
Severity: Major
Apixaban and Sulindac: 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
Taking an NSAID with apixaban raises the risk of bleeding, particularly gastrointestinal hemorrhage. The risk is greater in older patients and those with prior ulcers.
What this interaction means in plain words
Apixaban and Sulindac 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; Sulindac belongs to Musculoskeletal.
Why it happens
NSAIDs inhibit platelet function and damage gastric mucosa, adding to the anticoagulant effect of factor Xa inhibition.
What to do
Avoid the combination where possible and use paracetamol or other alternatives for pain. If unavoidable, use the lowest NSAID dose briefly, consider gastroprotection with a proton pump inhibitor, and monitor for bleeding and anemia.
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 Sulindac
- Ketorolac intranasal + Sulindac Contraindicated
- Ketorolac + Sulindac Contraindicated
- Aceclofenac + Sulindac Major
- Acetylsalicylic acid + Sulindac Major
- Alteplase + Sulindac Major
- Amiloride + Sulindac 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 Sulindac?
MediHelp rates the interaction as major. Apixaban and Sulindac 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. Taking an NSAID with apixaban raises the risk of bleeding, particularly gastrointestinal hemorrhage. The risk is greater in older patients and those with prior ulcers.
How serious is the interaction between Apixaban and Sulindac?
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 the combination where possible and use paracetamol or other alternatives for pain. If unavoidable, use the lowest NSAID dose briefly, consider gastroprotection with a proton pump inhibitor, and monitor for bleeding and anemia.
What other medicines interact with Sulindac?
MediHelp also lists interactions of Sulindac with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Sulindac page.
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