MAJOR — Use With Caution
FDA apixaban label recommends dose reduction when used with strong dual CYP3A4 and P-gp inhibitors. Consider alternative antibiotics.
Evidence level: STRONG
Clarithromycin can significantly increase apixaban (Eliquis) levels in your blood, raising your bleeding risk. Unlike warfarin, apixaban does not have routine blood monitoring, making this harder to detect.
Clarithromycin is a strong CYP3A4 and P-gp inhibitor. Apixaban is metabolized by CYP3A4 and is a P-gp substrate. Increased apixaban exposure and bleeding risk. FDA apixaban label warns about strong dual CYP3A4/P-gp inhibitors.
Tell your doctor you take Eliquis before starting any new antibiotic. Clarithromycin may require your Eliquis dose to be temporarily reduced. Ask about azithromycin as an alternative.
Monitor closely. Many antibiotics amplify anticoagulant effects by disrupting gut flora that produce vitamin K. Apixaban levels may spike during antibiotic courses. If on warfarin, request more frequent INR monitoring. Take each at their normal prescribed times.
Higher risk for: elderly patients, those with liver disease, history of GI bleeding, concurrent use of multiple blood thinners, recent surgery, vitamin K intake changes, alcohol use, or low body weight.
Unusual bruising, blood in urine or stool, nosebleeds, bleeding gums, prolonged bleeding from cuts
Discuss apixaban dose reduction during clarithromycin course. Consider azithromycin as alternative. No routine monitoring available unlike warfarin.
This medication combination requires careful medical oversight. Your doctor or anticoagulation clinic can adjust doses or select alternatives with fewer bleeding risks. Frequent INR monitoring is essential.
Clarithromycin can significantly increase apixaban (Eliquis) levels in your blood, raising your bleeding risk. Unlike warfarin, apixaban does not have routine blood monitoring, making this harder to detect.
Monitor closely. Many antibiotics amplify anticoagulant effects by disrupting gut flora that produce vitamin K. Apixaban levels may spike during antibiotic courses. If on warfarin, request more frequent INR monitoring. Take each at their normal prescribed times.
Unusual bruising, blood in urine or stool, nosebleeds, bleeding gums, prolonged bleeding from cuts
This medication combination requires careful medical oversight. Your doctor or anticoagulation clinic can adjust doses or select alternatives with fewer bleeding risks. Frequent INR monitoring is essential.
Discuss apixaban dose reduction during clarithromycin course. Consider azithromycin as alternative. No routine monitoring available unlike warfarin.
Or browse the full interaction database (121,000+ pairs).