Apixaban and Ketoconazole: Drug Interaction Guide
Quick answer: This is a major interaction — avoid combining Apixaban and Ketoconazole unless specifically directed by your doctor.
How Apixaban interacts with Ketoconazole
Ketoconazole is a strong dual inhibitor of CYP3A4 and P-glycoprotein, doubling apixaban exposure and substantially increasing bleeding risk.
What you should do
Avoid combination. If a systemic azole is essential, use fluconazole at lower doses with caution, or switch anticoagulant to LMWH.
Key facts
Severity
Major — avoid combination
Mechanism
Ketoconazole is a strong dual inhibitor of CYP3A4 and P-glycoprotein, doubling apixaban exposure and substantially incre...
Action
Avoid combination. If a systemic azole is essential, use fluconazole at lower doses with caution, or switch anticoagulan...
Frequently asked questions
Can I take Apixaban and Ketoconazole together?
No — this combination should generally be avoided. Avoid combination. If a systemic azole is essential, use fluconazole at lower doses with caution, or switch anticoagulant to LMWH.
What is the severity of this interaction?
The interaction between Apixaban and Ketoconazole is classified as Major — avoid combination. Ketoconazole is a strong dual inhibitor of CYP3A4 and P-glycoprotein, doubling apixaban exposure and substantially increasing bleeding risk.
What should I do if I'm prescribed both?
Avoid combination. If a systemic azole is essential, use fluconazole at lower doses with caution, or switch anticoagulant to LMWH. Always consult your prescribing clinician — do not stop or change medications without medical guidance.
Last reviewed: by iMedic Medical Editorial Team. Our editorial process.