From the Guidelines
Eliquis (apixaban) and Atorvastatin can generally be taken together safely, though there is a mild interaction between these medications. When taken together, atorvastatin may slightly increase the blood levels of apixaban by about 10-20% due to competition for metabolism by similar liver enzymes, specifically cytochrome 450 3A4 (CYP3A4) and P-glycoprotein (P-gp) 1. However, this interaction is not usually considered clinically significant enough to require dose adjustments for most patients. Key considerations for the safe use of Eliquis with Atorvastatin include:
- Monitoring for potential side effects such as unusual bleeding or bruising
- Informing all healthcare providers about all medications being taken
- Regular follow-up appointments to ensure both medications are working effectively and safely The benefits of taking these medications together, preventing blood clots with Eliquis and lowering cholesterol with Atorvastatin, typically outweigh the minimal risk of interaction, as there is no strong evidence to suggest significant adverse effects on morbidity, mortality, or quality of life 1.
From the FDA Drug Label
Apixaban is a substrate of both CYP3A4 and P-gp. Inhibitors of CYP3A4 and P-gp increase exposure to apixaban and increase the risk of bleeding. Apixaban is metabolized mainly via CYP3A4 with minor contributions from CYP1A2, 2C8, 2C9, 2C19, and 2J2.
Atorvastatin is a CYP3A4 inhibitor. Therefore, coadministration of atorvastatin with apixaban (Eliquis) may increase the exposure to apixaban and increase the risk of bleeding.
- The FDA recommends to decrease the dose of apixaban by 50% when coadministered with drugs that are combined P-gp and strong CYP3A4 inhibitors, however atorvastatin is not a strong CYP3A4 inhibitor.
- No specific dose adjustment is provided for atorvastatin and apixaban coadministration in the label. 2 2
From the Research
Eliquis (Apixaban) and Atorvastatin Interaction
- There is no direct evidence in the provided studies regarding the interaction between Eliquis (Apixaban) and Atorvastatin.
- However, the studies provide information on the safety and efficacy of Apixaban as an anticoagulant 3, 4, 5, 6 and the safety and efficacy of statin therapy, including Atorvastatin 7.
- Apixaban is a direct oral anticoagulant (DOAC) that is approved for the treatment and prevention of venous thromboembolism (VTE) and for the prevention of stroke in patients with nonvalvular atrial fibrillation 4, 6.
- Atorvastatin is a statin that is used to lower cholesterol levels and prevent cardiovascular disease 7.
- The studies suggest that Apixaban is effective and safe for the treatment and prevention of VTE and for the prevention of stroke in patients with nonvalvular atrial fibrillation 3, 4, 5.
- The studies also suggest that statin therapy, including Atorvastatin, is safe and effective for the prevention of cardiovascular disease 7.
- However, the interaction between Apixaban and Atorvastatin is not directly addressed in the provided studies.
Potential Interaction
- It is possible that the concomitant use of Apixaban and Atorvastatin may increase the risk of bleeding due to the anticoagulant effects of Apixaban and the potential antiplatelet effects of Atorvastatin.
- However, this potential interaction is not supported by the provided studies, and further research is needed to fully understand the interaction between Apixaban and Atorvastatin.
Clinical Implications
- Clinicians should be aware of the potential for interaction between Apixaban and Atorvastatin, although the evidence is limited.
- Patients taking Apixaban and Atorvastatin concomitantly should be monitored for signs of bleeding and other adverse effects.
- Further research is needed to fully understand the interaction between Apixaban and Atorvastatin and to provide guidance for clinicians on the safe use of these medications together.