Drug interactions
Apixaban + Vorapaxar
Severity: Major
Apixaban and Vorapaxar: 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
Vorapaxar is a PAR-1 platelet antagonist and adds to the bleeding tendency caused by apixaban. The combined effect raises the risk of serious bleeding, including intracranial hemorrhage. Vorapaxar labeling advises caution with anticoagulants and the combination is rarely justified.
What this interaction means in plain words
Apixaban and Vorapaxar 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.
Why it happens
Additive pharmacodynamic effect of platelet inhibition (PAR-1 antagonism) and factor Xa inhibition.
What to do
Avoid the combination where possible and reassess the need for vorapaxar. If both are essential, monitor closely for bleeding and check hemoglobin regularly.
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 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 Vorapaxar?
MediHelp rates the interaction as major. Apixaban and Vorapaxar 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. Vorapaxar is a PAR-1 platelet antagonist and adds to the bleeding tendency caused by apixaban. The combined effect raises the risk of serious bleeding, including intracranial hemorrhage. Vorapaxar labeling advises caution with anticoagulants and the combination is rarely justified.
How serious is the interaction between Apixaban and Vorapaxar?
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 reassess the need for vorapaxar. If both are essential, monitor closely for bleeding and check hemoglobin regularly.
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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