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Interactions

Using ELIQUIS with medicinal products affecting haemostasis1

Agents associated with serious bleeding
  • Concomitant treatment with any other anticoagulants (e.g., unfractionated heparin, low molecular weight heparins, heparin derivatives (fondaparinux, etc.), oral anticoagulants (warfarin, rivaroxaban, dabigatran, etc.))
Contraindicated except:
  • Under specific circumstance of switching anticoagulant therapy (see dosing section)
  • When unfractionated heparin is given at doses necessary to maintain an open central venous or arterial catheter
Other agents associated with serious bleeding (these include thrombolytic agents, GPIIb/IIIa receptor antagonists, thienopyridines (e.g., clopidogrel), dipyridamole, dextran and sulfinpyrazone) Not recommended
(please refer to SmPC for full information)
NSAIDs (including aspirin)
Antiplatelet agents
Use of ELIQUIS with antiplatelet agents or NSAIDs increases the risk of bleeding.

ELIQUIS to be used with caution if patients are treated concomitantly with NSAIDs including aspirin.

Interactions with inhibitors and inducers of CYP3A4 and P-gp1

Strong inhibitors such as azole antimycotics (e.g. ketoconazole) and HIV protease inhibitors (e.g. ritonavir) ELIQUIS is not recommend in patients receiving strong inhibitors of both CYP3A4 and P-gp.

Strong inhibitors may increase ELIQUIS exposure.
Strong inducers of CYP3A4 and P-gp (e.g. rifampicin, phenytoin, carbamazepine, phenobarbital or St John’s Wort) Strong inducers of both CYP3A4 and P-gp may reduce ELIQUIS exposure.

For VTE prevention in elective hip or knee replacement surgery, for stroke prevention in patients with NVAF, and for the prevention or recurrent VTE, ELIQUIS should be co-administered with caution.

For the treatment of VTE, ELIQUIS should not be used since efficacy may be compromised.

Please consult the ELIQUIS® SmPC for further information on interactions.

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AUC = Area Under the Curve   
ALT = Alanine Transaminase   
AST = Aspartate Transaminase   
CV = Coefficient of Variation   
CYP3A4 = Cytochrome P450 3A4   
GI = Gastrointestinal   
HIV = Human Immunodeficiency Virus   
NSAID = Non-Steroidal Anti-Inflammatory Drug   
PD = Pharmacodynamics   
P-gp = P-glycoprotein
PK = Pharmacokinetics   
SmPC = Summary of Product Characteristics   
ULN = Upper Limit of Normal

Reference

  1. ELIQUIS® (apixaban) Summary of Product Characteristics.